Job Description

Director, Payer Contract & Pricing Analytics

Cancer care is all we do

Hope in healing

Cancer Treatment Centers of America® (CTCA®) takes a unique and integrative approach to cancer care. Our patient-centered care model is founded on a commitment to personalized medicine, tailoring a combination of treatments to the needs of each individual patient. At the same time, we support patients’ quality of life by offering therapies designed to help them manage the side effects of treatment, addressing their physical, spiritual and emotional needs, so they are better able to stay on their treatment regimens and get back to life. At the core of our whole-person approach is what we call the Mother Standard® of care, so named because it requires that we treat our patients, and one another, like we would want our loved ones to be treated. This innovative approach has earned our hospitals a Best Place to Work distinction and numerous accreditations. Each of us has a stake in the successful outcomes of every patient we treat.

Job Description:

The Director of Payer Contract & Pricing Analytics is responsible for leading CTCA’s analytics and reporting function, specifically to support payer contract evaluation and negotiations, reimbursement projections, pricing strategy, contract performance and optimization, revenue cycle and revenue integrity, chargemaster, and contract compliance across the entire CTCA payer portfolio.  In close collaboration with the Payer Relations and Revenue Cycle teams, the Director will lead the development of pricing strategies, reimbursement terms, and contract modeling to offer in-depth understanding of managed care contract policies and value for contracts through pre- and post-implementation.  Additionally, the Director may participate in the development of value-based care strategies and initiatives to assess value-based payment models, evolving healthcare payment reforms, and payment methodologies. The Director will collaborate across the organization to develop and implement value propositions and own the responsibility to identify and prioritize the strategic initiatives related to healthcare economics and contract compliance ensuring those are delivered.

Job Responsibilities

Leadership and Management: The Director will lead CTCA’s payer, pricing, revenue cycle, and revenue integrity analytics.  The Director will lead a team of managers, senior analysts, and analysts who support those functions.  The Director will set a vision for the team’s contributions to the enterprise and expanding need to support managed care contracts, establish annual goals, develop and grow talent, and drive innovation and efficiency in the pursuit of better service to our customers. The Director will also manage relationships with applicable vendors, external consultants, and contractors.

Pricing:  The Director is responsible for the development and maintenance of CTCA’s pricing strategy, both in the current fee-for-service environment and the evolving value-based care market.   Working with leadership, the Director will work toward ensuring defensible and transparent pricing that conforms with the pricing strategy of the enterprise.  The Director will also develop innovative pricing strategies to provide perspective on contract terms and policies impacting employer and payer reimbursement including approaches for regional markets and anticipate potential pricing changes.

Analytics/Health Economics Thought Leadership. The Director will lead an analytic team to quantify the impact of alternative proposals before and during negotiations, develop pricing strategies and modeling across the entire CTCA payer and employer portfolio, and provide technical insight into new initiatives in value-based payment. The Director will also develop and advance analytic capabilities of revenue cycle, revenue integrity, reimbursement innovation, and functional excellence to support value-based products and initiatives. The Director will monitor developments in value-based payment and recommend competitive and viable financial structures for new and existing contracts.

Payer Negotiation. The Director will partner with CTCA leadership to assess the value of payer contract proposals and develop negotiation processes through proposal evaluation and development. This role will also assist with the design and implementation of strategic partnerships with key payers to deliver shared value, improve costs, quality, patient experience, support managed care, and value-based care, delivery.

Contract Compliance and Performance. The Director will develop and implement policies ensuring they are governed properly to optimize contract compliance and performance and collaborate with CTCA leadership to ensure the contract requirements are being met. The Director will lead oversee analytics related to contract compliance, reporting requirements, and implementation of contract updates coordinating with revenue cycle, finance, payer access departments and other relevant departments.

Skills, Education and Additional Information

  • A Bachelor's Degree in business, economics, healthcare administration, or a related field is required.

  • Ten or more (10+) years of experience in healthcare analytics, preferably within provider and/or payer settings, with at least five or more (5+) years of experience or knowledge of managed care, healthcare economics, managed care pricing, product/network development or management.

  • Proactive, forward-thinking approach to meet the future needs of an evolving organization, with a specific interest and ability to develop an analytic strategy, and implement it, to support the organization

  • A minimum of five years successful leadership/management experience.

  • Experience in managing and building a highly skilled analytics team.

  • Extensive thorough knowledge of payer/provider pricing, healthcare finance, medical unit cost management/budgeting, payment models and payment structures.  This position will have insight into developing the appropriate structure to support CTCA contracting objectives.

  • Extensive knowledge of payer claims operations, processing, platforms, and claims optimization.

  • Significant experience with contract negotiations and payer relations, as well as demonstrated knowledge of legal, regulatory, and operational aspects of managed care.

  • Experience and understanding of new and evolving value-based payment arrangements and related financial/actuarial models, such as capitation, shared savings, and payment bundles.

  • Experience and understanding of payer delegated models and strategies, inclusive of CMS Star Ratings, HEDIS, CAHPS, HCC, and other quality, utilization, and financial models.

  • In depth knowledge of managed care contracts and hospital managed care finance, claims payment, methodologies, procedures, controls and CPT, HCPCS, ICD-10, DRG coding.

  • Significant experience with healthcare data (medical/payer claims, encounter data, and remits) and considerable knowledge of billing and collection process across provider types. 

  • Proficiency in MSO products and experience with relational databases (e.g. SQL, PIC, Business Objects, Tableau, QlikView, or similar)

  • Displays a high level of critical thinking to address complex business problems.

  • Presentation and communication skills required.  Analytical and problem solving required. 

  • Strong problem solving and analytical skills; ability to utilize and interpret financial models and internal analyses.

  • Effective negotiation and communication skills, and ability to collaborate with varying individuals throughout the system as well as with external payers and vendors

  • Ability to develop and maintain professional relationships, maintain confidentiality, and to manage multiple tasks simultaneously.

We win together

Each CTCA employee is a Stakeholder, driven to make a true difference and help win the fight against cancer. Each day is a challenge, but this unique experience comes with rewards that you may never have thought possible. To ensure each team member brings his or her best self, we offer exceptional support and immersive training to encourage your personal and professional growth. If you’re ready to be part of something bigger and work with a passionate, dynamic group of care professionals, we invite you to join us. 

Visit:  Jobs.cancercenter.com to begin your journey.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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