Program Manager, Revenue Management Analytics (Remote-US)

Thank you for considering a career at Bon Secours Mercy Health!

Scheduled Weekly Hours:

40

Work Shift:

Days/Afternoons (United States of America)

SUMMARY

The Program Manager of Revenue Applications is responsible for the creation and designing of data reporting platforms and tools that help others on the revenue management team with government reporting, revenue analytics and insights, data extraction, and adhoc reporting business and clinical information needs. The Program Manager of Revenue Applications ensures that the whole portfolio of assets created are properly developed, managed, maintained, updated, sunset and properly documented as part of the effective operation of BI as well as a key component of Data Governance. This position will need to forge working relationship/partnership with leaders, analysts and communities at all levels, while working in a team sought out for their expertise and skills with data communication. The incumbent will develop in depth knowledge of the reporting tools available and source data models. This position will manage relationships with all user communities as well as provide proper support and education to leaders and analysts outside of the Revenue Analytics team to assure effective use and understanding of data to drive improvements in how healthcare is delivered in BSMH. The scope of reporting will primarily include facilities, ancillaries, physicians, PHOs and clinically integrated networks across the footprint of Bon Secours Mercy Health.

ESSENTIAL JOB FUNCTIONS

• Architect BI solutions from the ground up including the modeling of the conceptual, logical, and physical layers of the data.

• Develop tools and reporting to support the following:

  • Operations analytics on timeliness and accuracy of contract loading

  • Payor analytics and tracking around Fee Schedule, Grouper and CDM notifications

  • Work with modeling vendors to develop robust payor performance reporting around behavior including denials, underpayments, patient responsibility and other administrative or policy burdens

  • Create reports to support auditing and accuracy of Epic modeling performed by Ensemble

  • Maintain and enhance Revenue Management databases for standardized reporting on Managed Care Analytics for Hospitals, Medical Group and Ambulatory/Ancillary

  • Track the performance of Revenue Management vendors in relation to their SLA’s documented in the contract

  • Payor/Plan mapping and standardization

• Communicate trends and insights on a monthly and quarterly basis that can be used by both operators and the revenue management team

• Develop market strategy packets to be used by both the Managed Care Negotiators and Modeling teams to drive decision making

• Create and Manage an Intake process around adhoc revenue analysis requested by senior leadership

  • Develop and maintain report request and tracking tool

  • Ability to autonomously perform all necessary research to fulfill requests

  • Utilize research and collaboration amongst team members to deliver insightful reports that exceed customer expectations

  • Deliver reports on a timely basis based on established turnaround time expectations set by senior leadership

• Work within the markets as necessary on the standardization of processes, reporting and approaches to payer contracting, payer relationships, network participation and other strategic project from time to time.

• Leads and participates in short and long term projects, as needed.

• Continuously manages the updates and expands integrations of reporting SQL server and data tables to enhance insights and supports ETL automation efforts

• Maintains knowledge and understanding of the current trends and developments in healthcare reimbursement and development of specific payer strategies, including investigation of new business opportunities, regulations, standards and directives regarding governmental/third party agencies (Medicare & Medicaid) and/or third party payers.

• Adheres to the standards and policies of the Corporate Responsibility Program, including the duty to comply with applicable laws and regulations, and reporting to designated Manager (or employer hotline) any suspected unethical, fraudulent, or unlawful acts or practices.

• Responsible to continuously evaluate BI tools (Tableau, Power BI, Cognos, etc) to understand which tools should be used by BSMH to be successful and develop a world class analytics platform by developing a strategic roadmap that best balances capabilities and costs (resources and dollars).

• Participates in and encourages associates to participate in activities that benefit the community.

• Performs other duties and responsibilities as may be assigned from time to time.

EMPLOYMENT QUALIFICATIONS

Education:

• 4 year/ Bachelors Degree in Business Intelligence, Data/ Business Analytics, Data Science, Computer Science, Health Informatics, or related fields (required)

• Graduate Degree (Masters) in Health care administration, accounting or finance (preferred)

Licensure/Certification:

• CRCR, CSBI, CSMC, CHFP (preferred)

Experience:

• 5-7 years of technical analytics experience (required)

• Experience should be a combination of the following: 1-2 years of advanced SQL scripting, 1-2 years building SSIS packages, 1-2 years developing power BI dashboards, 1-2 years healthcare data mining (required)

Other Knowledge, Skills and Abilities:

• Excellent interpersonal skills to interact with all levels of staff, outside vendors, consultants, and physicians.

• Strong analytical, verbal and presentation skills; SQL; experience in financial modeling and reimbursement technologies; proficient in spreadsheet and database programs as well as legal and contractual compliance issues.

• Ability to establish relationships with internal customers and managed care entities.

• A broad knowledge of the healthcare industry, insurance, managed care and integrated delivery systems as well as employer benefit plans.

• A background in healthcare finance, payer reimbursement methodologies and decision support leadership is preferred.

• Must have the ability to timely and accurately mine data from various internal and external sources and organize information in a meaningful way for presentation and analysis.

• Must possess critical thinking skills, an ability to work cooperatively with others and have a positive, willing attitude.

Bon Secours Mercy Health is an equal opportunity employer.

Many of our opportunities reward* your hard work with:

• Comprehensive, affordable medical, dental and vision plans
• Prescription drug coverage
• Flexible spending accounts
• Life insurance w/AD&D
• Employer contributions to retirement savings plan when eligible
• Paid time off
• Educational Assistance
• And much more

*Benefits offerings vary according to employment status.

Department:

SS Revenue Management - Revenue Management

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health– Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employer, please email [email protected]. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [email protected].