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System Director Payment Transformation

Company: Dignity Health System Office
Location: Rancho Cordova
Posted on: May 5, 2022

Job Description:

Overview
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Responsibilities
Job Summary
The System Director, Payment Transformation is accountable for data analytics and financial performance analysis activities for CommonSpirit Health's value-based agreements (VBA) and initiatives. The Director develops and recommends strategies for maximizing reimbursement and market share from value-based programs and payment models. Designs and influences participation strategies related to new value-based initiatives with payers that are consistent with established strategic priorities. Provides VBA program education to key stakeholders.
This role is a key member of the Population Health Insights leadership team and contributes to the development and implementation of system and local strategy, transformation to a clinical enterprise, successful population health and physician alignment strategies, and achievement of value-based growth goals.
Essential Key Job Responsibilities

  • Lead and manage the operations of the Payment Transformation team including the orienting, developing, and managing a staff of managers and analysts.
  • Review and accurately interpret value-based program terms, including development of policies and procedures in support of value-based program participation.
  • In conjunction with Payer Strategy & Relationships, perform financial opportunity analysis for VBA contracts, spanning commercial and government payers.
  • Oversee the preparation of risk-share/gain-share funds flow models and financial distribution reports of VBA payments and repayments. Calculate expected and actual revenues/volumes, population risk calculations, past performance, and impact of proposed program terms and program/regulatory changes.
  • Create complex financial performance analyses (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised VBA strategies, approaches, provisions, parameters and rate structures aimed at establishing appropriate reimbursement levels.
  • Support Population Health initiatives and VBA Clinical Strategy with data analyses, reports, dashboard development and maintenance, and presentations as needed.
  • Continued analytic support of performance and performance opportunities throughout the duration of value-based agreements.
  • Lead the identification, collection, and manipulation of data from a wide variety of financial and clinical internal databases and external sources (e.g., Medicare/Medicaid website, CMS SAF files, etc.). Identify and access appropriate data resources to support analyses and recommendations.
  • Prepare and effectively present VBA analysis results to senior leadership, Operations/Population Health leaders, and other key stakeholders, for review and decision-making.
  • Maintain knowledge of operations sufficient to identify causative factors, deviations, allowances that may affect reporting findings. Ability to translate operational knowledge to identify unusual circumstances, trends, or activity and project the related impact on a timely, pre-emptive basis.
  • Take accountability for designated reimbursement and accounting systems; be proficient in reading, interpreting, and formulating complex computer system programming/rules.
    Qualifications
    • Bachelor's Degree in Business Administration, Accounting, Finance, Healthcare or related field. - Master's degree preferred.
    • Minimum of eight (8) years' experience in large healthcare organizations and/or integrated healthcare delivery systems.
    • Minimum of five (5) years' strategic leadership of healthcare pricing, population health analytics, value-based agreement negotiation, and/or healthcare economics in a complex, national or multi-regional healthcare system or health insurance environment.
    • Advanced level knowledge of SQL and Excel.
    • Advanced knowledge of value-based payment models, including shared savings, bundled payments, pay-for-performance, and capitation.
    • Strong background in financial healthcare/value-based reimbursement analysis.
    • Must be able to lead and coordinate projects through various complex and challenging situations to completion under time-sensitive deadlines.
    • Ability to communicate effectively, both orally and written, and provide formal reports, prepared for leadership at all levels.
    • Intermediate level knowledge and comfort with Google Suite products a plus.
      A compensation range of $123,000 - $160,000 is the reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
      While you're busy impacting the healthcare industry, we'll take care of you with benefits that include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility and more
      #missioncritical#DH-LI

Keywords: Dignity Health System Office, Rancho Cordova , System Director Payment Transformation, Executive , Rancho Cordova, California

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