The purpose of this position is to provide advanced financial analysis and modeling for Hospital rate setting and profitability reporting related to third party Payor contract negotiations with insurance companies, government agencies and other external entities. This position is also responsible for contract coding and system maintenance for the EPIC Contract Management Systems (CMS), and monitors contents and coding for external JDA Parathon CMS. This position also completes ad hoc financial projects and provides financial and variance analysis and reporting on Payor performance and collectability for OHSU Management and OHSU Affiliated Partners.
1. Develops managed care contract rates, leads analytical support for decision making during Hospital contact negotiations, and provides Payor performance and variance reporting for all third party payer contracts (i.e. HMOs, PPOs, and Government Agencies):
Completes advanced financial analysis and modeling of patient charges and costs to include the following:
Database retrieval, including creation and use of complex SQL queries against the Data Warehouse, performs validation, and organizes patient information for contract models.
Builds complex financial models and performs scenario analyses of Payor reimbursement using patient data and contract terms. Analyzes impact of counter and final proposals.
Develops summary presentation of rate proposal for executive leadership with rationale and recommended options.
Initiates, develops and provides Payor performance reports to leadership of charges, costs and profitability.
Monitors and analyzes variances between negotiated contract payment terms and contract performance to ensure actual reimbursement is consistent with expected payment calculations. Reports finding of collection issues to leadership, and provides alternative recommendations for future contract terms or methodologies.
Develops and maintains contract rates and terms databases, tools and comparative Payor metrics.
Researches on-going Payor policy changes and provides recommend response and net revenue impact analysis to leadership.
Stays current with the changes in reimbursement methods as it relates to CMS Medicare final rules, and value based contracting models.
Develop and maintains working relationship with Managed Care Contracting department to facilitate timely responses to contract proposals and other rate setting contracting priorities.
2. Codes Government and Commercial Payor contract terms and maintains EPIC Contract Management System (CMS). Monitors and validates Payor contract coding for external JDA Parathon CMS.
Analyzes Government Agency regulations and third party payer contracts and convert reimbursement terms into EPIC contract management systems payment calculations with the use of system structure and schema.
Works jointly with Managed Care Contracting, Patient Business Services, Insurers and Government Agencies to interpret and clarify payment terms, identify and resolve contract coding issues, and make recommend contract language modifications to secure accurate expected reimbursement.
Monitors daily data file transfer process into EPIC contract systems and investigates and resolves problems relating to data and data interfaces for EPIC.
Responsible for the maintenance of quarterly and annual government statistical metrics necessary for the accurate calculation of expected reimbursement in the 3M Grouper Plus software and EPIC master tables.
Serves as Hospital Financial Services contact for IT related system upgrades, fixes and troubleshooting for EPIC CMS.
Serves as OHSU lead contact for contract coding and modeling database issues for JDA CMS. Coordinates with OHSU PBS, ITG and JDA to troubleshoot and monitor interface issues and fixes.
3. Completes routine and ad hoc analytical projects as needed and assigned by Manager for OHSU and OHSU Affiliated Partners to include the following:
Identifies the appropriate source of data, selects appropriate criteria for analysis, and ensures data is reflecting consistent assumptions.
Completes routine review of financial results for reasonability, consistency and accuracy.
Analyzes trends, makes projections, and generates reports.
Meets with customers and key stakeholders to provide insight into key financial indicators and explain analytical results. Makes recommendations to customers based upon financial outcomes of analysis and performance measures consistent with OHSU business strategies.
Serves as a key analytical resource as assigned and attends regular meetings with customers and key stakeholders as needed
Develops and maintains procedure documentation that relates to this position.
As the state's only health and research university, OHSU brings together patient care, research, education of the next generation of health care providers and scientists and community service to improve the health and well-being of all Oregonians.The university is a conduit for learning for more than 2,800 students, providing training to interns, residents and fellows in postgraduate medical and research. It is the only place in Oregon that grants doctoral degrees in medicine, dentistry and nursing. OHSU cares for more than 251,000 patients each year from around the region and takes a leadership role in contributing to solutions involving the health of the state and the nation, such as health care access and transparency, ethics and workforce shortage. Beyond providing critical health care services, quality education and cutting-edge research, OHSU also is a key economic and social force in the Northwest. With an annual operating budget of $2.06 billion and more than 14,000 employees, OHSU is Portland?s largest employer. Its size contributes to its ability to provide... many services and community support activities not found anywhere else in Oregon. For more information visit http://www.ohsu.edu/xd/about/index.cfm