Director Managed Care Analytics

Ou Health - Oklahoma City, OK

Full-time - Director

Oklahoma City, OK

About the position

The Director of Managed Care Analytics at OU Health is responsible for overseeing payer reimbursement modeling and providing data analytic support to the Managed Care Contracting functions. This role involves transforming claims and clinical data into actionable reports, designing contract performance dashboards, and participating in contract negotiations. The Director will manage financial components of active contracts and evaluate financial strategies for payer proposals, ensuring alignment with Managed Care goals and the viability of service lines and health plan products.

Responsibilities

• Develop dashboards and ad-hoc reporting with minimal guidance in Excel/Tableau/PowerPoint
• Perform complex data analysis and contract modeling support of ad-hoc and standing management or customer requests
• Collaborate with cross-functional teams, including clinical, technical, and finance teams
• Validate data extracts and analyze any data variances
• Conduct service line managed care reimbursement analysis as requested by Management
• Work with applicable teams to develop value-based contract measures and metrics
• Manage the calculation and implementation of contract escalation language and system impacts
• Identify and integrate data from multiple sources to build reimbursement models, dashboards, and reports
• Develop and perform routine and ad-hoc reporting to evaluate performance and identify opportunities for process improvements
• Perform statistical analysis of data extracted from various internal sources and prepare reports based on findings
• Proactively identify data trends and outliers and provide suggestions for causes, remedies, or process improvements
• Compile, design, and analyze data and information; develop clear and concise reports for distribution
• Create and maintain business process and technical workflow documents
• Act as managed care analytics SME on multi-disciplinary teams
• Supervise, coach, and mentor Manager, Managed Care Analytics
• Perform other duties as assigned

Requirements

• Bachelor degree in Business, Finance, Health Care, Economics or related field is required
• 5 to 7 years of progressive leadership experience required, preferably within an academic medical center, multi-hospital health system or managed care organization
• Demonstrated experience in healthcare analytics and medical economic modeling
• SQL, Tableau, and Strata experience preferred
• Epic Resolute PB and HB certification required or must obtain both within 6 months of hire
• Strong knowledge of hospital and physician reimbursement methodologies
• Working knowledge of billing/coding terminology
• Procedural knowledge of hospital and physician practice accounts receivable management
• SQL subject-matter-expert focusing on data queries
• Proficiency with EPIC, Experian and/or other contract management systems
• Financial and analytical skills necessary to interpret complex quantitative information
• Detail oriented with effective research and problem-solving skills
• Strong understanding of healthcare data including cost of care and patient utilization metrics
• Knowledge of medical coding (ICD, CPT) and business terminology
• Detailed knowledge with both Medicare and commercial provider reimbursement methods
• Ability to access data using information systems for analysis and reporting
• Proficient with SAS, SQL server database, Microsoft Excel, Microsoft Word, Power BI, Python

Nice-to-haves

• MBA, MHA or related master's degree preferred
• Proficiency with EPIC, Experian and/or other contract management systems preferred

Benefits

• PTO
• 401(k)
• Medical and dental plans
• Comprehensive benefits package