Job Description

Location: Steward Medical Group - West
Posted Date: 7/20/2021

POSITION SUMMARY:
Reporting to the Manager, Payor Intelligence, this position participates, indirectly or directly, in Corporate health plan contract negotiations and is responsible for facilitating contract analytics, implementation, and ongoing issue management for assigned payors, divisions, and/or programs within the medical group. The position deals with external constituents, including Corporate Contract payors, third party administrators and insurance companies, as well as internal constituents within Steward Healthcare, including Managed Care, Central Business Office, Finance, and clinical departments. Duties are assigned in accordance with priorities and strategies tied to payor relations, payor contracting, and payment innovation.

KEY RESPONSIBILITIES:

  • Analyzes contract profitability and provides recommended prioritization of re-contracting efforts to SMG Leadership and Managed Care and Contracting.
  • Supports payor strategy and innovation in negotiations with managed care organizations and/or insurers to obtain provider services agreements that advance the profitable growth of Steward Medical Group. This may include advanced professional analytics, contract modeling, and contract language review.
  • In conjunction with assigned leadership, facilitates internal review of operational requirements to ensure that provider agreements can be supported, and that key deliverables or performance targets may be upheld. Upon receipt of proposed contract terms, performs objective data analysis to understand the impacts and makes recommendations in support of the priorities and needs of assigned provider entities.
  • Responsible for proactively managing time frames for assigned deliverables, including obtaining fee schedule changes and contract term updates in a timely manner.
  • Delivers critical information concerning covered services, par providers, carve-outs, and fee schedules to affected internal clients in a timely manner.
  • Supports quality program initiatives through deliverables as assigned in coordination with department leadership.
  • Other duties as assigned.


REQUIRED KNOWLEDGE & SKILLS:

  • Bachelor's degree in a related field such as healthcare administration or business preferred.
  • Minimum 2 years’ experience in an analytical role within the healthcare industry, with an emphasis on financial or reimbursement analytics.
  • Ability to use creative thinking to analyze workflow processes and create tools/applications that aid in the accuracy and efficiencies of provider reimbursement.
  • Ability to manage efficiently and effectively large, complex data sets and devise meaningful information and reports from data sets.
  • Ability to effectively prioritize and manage multiple priorities while meeting deadlines
  • Communication (written, verbal, listening), teamwork, attention to detail, leadership, problem-solving, research, troubleshooting, and organization skills
  • Prior experience with Athena and Trizetto preferred.

Steward Health Care is the largest private, for-profit health care network in the United States. The company is owned and led by a management team of Steward physicians. Headquartered in Dallas, Texas, Steward employs more than 40,000 health care professionals and operates 35 hospitals across the United States and in the countries of Malta and Colombia which regularly receive top awards for quality and safety. The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, more than 7,000 beds under management, and approximately 2.2 million full risk covered lives through the company's managed care and health insurance services.

The Steward Health Care Network includes more than 5,000 physicians across 800 communities who help to provide more than 12 million patient encounters annually. Steward Medical Group, the company's employed physician group, provides more than six million patient encounters per year. The Steward Hospital Group operates hospitals in Malta, Colombia and nine states across the U.S., including Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah. For more information, visit www.steward.org.

Steward Health Care is an Equal Employment Opportunity (EEO) employer, Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.

Additional Information

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Steward Medical Group is taking additional necessary preparations to ensure patients can receive compassionate care in safe, carefully managed environment – with confidence and without fear.

Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience.

  • Any COVID-19 related care takes place in designated areas away from other patients and their families.
  • A stringent cleaning policy has been implemented throughout our facilities.
  • A strictly controlled visitor and mask policy is required for patient and colleague safety.

Application Instructions

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