VP, Payer Analytics

Employment Type:Full timeShift:

Description:

POSITION PURPOSE

The position will be based in Livonia, Michigan with remote opportunity.

The Vice President of Payer Analytics is responsible for executive leadership over all analytics related to Trinity Health payer contracts including, fee for service contracts, bundled payment arrangements, upside and downside risk models, capitation contracts and pay for performance programs. This includes all analytics pertaining to payer contract modeling and performance for all provider types including acute inpatient and outpatient services, professional services, skilled nursing, home health and other ancillary services. The Vice President of Payer Analytics also oversees all financial analytics necessary to support product development activities with payers and employers including establishing criteria and frameworks to evaluate product opportunities in direct-to-employer, Medicare, Medicaid, and public and private healthcare insurance exchanges

The Vice President of Payer Analytics also oversees the development and launch of innovative products, services, and go-to-market strategies for employer, government and healthcare insurance exchange markets and monitors marketplace evolution and ensures that relevant and financially viable products are developed.

This critical position within Trinity Health will be responsible for accurately determining the true costs of care, future trends and accurate assessment of the potential revenues and costs associated with target populations that are critical to ensure the future growth and profitability of the organization.

ESSENTIAL FUNCTIONS

1.Provide ongoing analysis and determination of health care costs and trends to the payer strategy and product development organization. Develop reporting systems and processes to determine costs of care quickly and accurately for all products and services offered.

2.Develop, direct and implement (in concert with IT support) methodologies for evaluation and comparison of medical cost and utilization analysis, planning, forecasting and provider profiling.

3.Develop and continually refine the health care cost analysis process. Oversee the development and organization of information and play an active and engaged role in the use of information in the development of aggressive and integrated strategies and interventions regarding health care costs.

4.Provide guidance on medical expense budgeting including identifying utilization targets and corrective action plans. Conduct analyses of medical costs and utilization using statistical principles and tools.

Participate in the strategic development of contracts and business relationships related to new products and markets. Responsible for ensuring terms and commitments are consistent with the corporation’s goals and objectives.

6.Play an integral role in all major business decisions, defining the estimated financial impact of such decisions.

7.Oversee the implementation of pricing policies and procedures that are consistent with the corporation’s strategic marketing and financial/operational plans.

8.Establish and continually refine processes and procedures to determine cost structures, trends and issues of critical financial importance. Coordinate reporting of product information to tie with company financials and trend analysis reports.

9.Develop and oversee the analytics to support all contract negotiations with payers for all types of providers and reimbursement methodologies.

10.Develop and oversee the analytics and reporting to routinely monitor and evaluate the performance of all executed agreements with payers.

11.Develop all reporting needed to support management of the entire contracting lifecycle including all contract maintenance activities.

12.Serve as business owner of Trinity Health's population health analytic platform and software.

13.Develop and maintain standard procedures, processes and policies with respect to receiving claims data from payers and employers.

14.Provide support in areas of medical cost management and variance analysis. Drive the performance of ongoing analysis and evaluation of fee schedules, benefit design impact and contract financial terms for existing and new market products and customers.

15.Work in conjunction with the senior management team to create and execute organizational goals and objectives. Build strong, collaborative partnerships between medical economics, Clinically Integrated Networks and other operating groups within Trinity Health to facilitate and drive key deliverables.

16.Develop credibility for the organization by providing timely, accurate and actionable medical trend data to key stakeholders.

Creates work plan templates to guide the development and implementation of Medicare, Medicaid and individual products with payers. Anticipates the need for and develops sound, profitable products that win market share in the emerging world of retail based individual products as well as group markets.

Develops and launches products jointly with payers in accordance with the opportunities outlined in each Regional Health Ministry's (RHM) payer-oriented strategic plan.

19.Oversees the design and sale of "insurance" products sold directly to employers.

20.Supports CHE Trinity Health’s clinically integrated networks (CINs) in designing and building high performance networks.

Assesses each market and their competitive offerings to identify and tai lor product offerings for each market segment. Ensures that all offerings and adjustments are administratively feasible, in compliance, and financially sound. Ensures products meet needs of employers, groups and/or individuals.

Determines the strategic positioning of the group and/or individual products and works with marketing resources to correctly position each product. Develops and oversees the execution of a product strategy and execution roadmap in collaboration with key stakeholders.

Oversees activities to understand the evolving markets including monitoring competitor actions, consumer behavior and purchaser needs. Supports the contracting, risk analytics, and sales teams by developing marketing, communication and sales tactics to meet their goals. Provides consistent communication on progress and results of those efforts.

LEADERSHIP COMPETENCIES

As a Trinity Health Executive, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below:

Mission Statement: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

• Reverence: We honor the sacredness and dignity of every person.

• Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.

• Justice: We foster right relationships to promote the common good, including sustainability of Earth.

• Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.

• Integrity: We are faithful to those we say we are.

• Safety: We embrace a culture that prevents harm and nurtures a healing, safe environment for all.

MINIMUM QUALIFICATIONS

The qualified candidate will have a bachelor’s degree in finance, business or accounting, with an MBA or a master’s degree in health care economics and/or CPA/CMA preferred.

A minimum of ten (10) years of finance experience in the health care field is preferred. This individual must have a minimum of ten (10) years of progressive management and leadership experience.

Knowledge of generally accepted accounting principles (GAAP) is a must. Alternately actuarial experience and FSA designation will be considered.

In-depth knowledge and experience of analysis and reporting regarding health care costs within a managed care organization. This should include ability to budget such costs, compare and analyze actual to budget, project cost trends and manage IBNR as needed.

Experience dealing with the array of business elements that drive health care costs within a payer organization, and the potential interventions available to affect those costs. Familiarity with the financial and business issues relevant to those interventions.

Ability to take part in development of strategies and interventions to affect costs.

In-depth knowledge and experience in budgeting, financial planning, analysis and forecasts for a payer entity.

Experience in cost benefit analysis and development of valuation statements of member value.

Proven experience in direct analysis of financial results, including variances from forecast, on a monthly and annual basis. Ability to identify trends and produce revised forecasts.

Proven ability to make recommendations to and provide senior management with financial decision-making support.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

Must be able to adapt to frequently changing work priorities.

Must be able to travel as needed to the various Trinity Health sites.

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.