The purpose of this position is to provide advanced financial analysis and modeling for OHSU Physician rate setting and performance reporting related to third party Payor contract negotiations with insurance companies, government agencies and other external entities. This position will use a variety of systems and tools to provide internal support for Managed Care Contracting Department (MCCND) during contracts renewals with the review, evaluation and preparation of managed care contract rate proposals. This position will also manage ongoing financial reporting for OHSU management and administration.
1. Develops managed care contract rates, leads analytical support for decision making during contract negotiations for fee for service and value-based models that cover physician, hospital and ancillary providers/services:
Completes advanced financial analysis and modeling of patient claims utilizing current contract modeling systems in place to include the following:
Performs scenario analyses of Payor reimbursement using patient claims 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.
Prepares contract payment terms for Experian system load, and validates correct coding for all completed contracts.
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 and contracting priorities.
2. Provides payor performance and variance reporting for all third party payor fee for service and value-based contracts (i.e. HMOs, PPOs, and Government Agencies):
Initiates, develops, maintains 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.
3. Researches on-going Payor policy changes and provides recommend response and net revenue impact analysis to leadership.
4. Completes ad hoc financial projects and analyses as needed and assigned by Manager or other HFS leadership. 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