Director, Payor Strategy & Analytics at Fresenius Medical Care

Waltham, Massachusetts, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, MedicalIndustries

Requirements

Bachelor's Degree in Accounting / Finance or Business or Health Management
Minimum 6 years of experience to include financial analysis in healthcare environment
3+ years' experience as a Manager; or 3+ years' experience in a senior managerial role
Demonstrated experience managing one or more departments
Strong management skills with the ability to lead cohesive and productive teams
Strong interpersonal skills with the ability to communicate with all levels of management through diplomacy and tact
Excellent oral and written communication skills
Proficient with PCs and Microsoft (tools/software)

Responsibilities

Participates in and communicates the FMCNA culture through customer service standards with billing groups, finance, IT, facilities and payers
Develops and maintains relationships through effective and timely communication with all
Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner
Responsible for complying with all related FMCNA policies and procedures
Responsible for timely and accurate communication of revenue reporting to Managed Care Management Team
Responsible for compliance with all related data collections and auditing activities
Performs various national and global financial analyses to assist with contract proposals including determining project specifications and review methodologies (e.g., review of claims data, analysis of medication utilization for global contracts, analysis of rate structure conversion)
Consolidates patient insurance download data including developing standards for field review of data and reporting
Provides consolidated business / payer mix / revenue by payer / treatment mix on a monthly basis including developing departmental policies for data collection and reporting
Develops and produces analytical reports to support managed care efforts on a monthly or as needed basis
Coordinates requests for proposals including collection of data, evaluation of proposals and recommended course of action
Responsible for monthly review of P&L accounts to identify loss and marginal facilities tied to payer mix
Reviews billing accuracies to ensure that projected revenue is being realized
Maintains consolidated report which specifically lists and tracks all patients reimbursing according to commercial rates or single patient Letters of Agreement
Develops and maintains consolidated payer class revenue per treatment report and payer mix reports
Development and maintenance of contract and commercial patient database(s)
Responsible for preparing and updating monthly consolidated revenue per treatment templates and charts
Performs quarterly analysis of network data for growth
Performs and maintains competitive insurance analysis of individual markets and competitive provider activity
Maintains database on health plan membership by product
Other duties as required
May be responsible for the direct supervision of various levels of revenue cycle staff

Skills

financial analysis

revenue reporting

data consolidation

claims data analysis

medication utilization analysis

P&L review

budgeting

forecasting

contract proposals

managed care analytics

SQL

Excel

payer mix analysis

Fresenius Medical Care

Provides dialysis and renal healthcare services

About Fresenius Medical Care

Fresenius Medical Care North America focuses on delivering high-quality healthcare services to individuals with kidney and other chronic conditions. The company operates a vast network of dialysis centers and outpatient labs for cardiac and vascular care, ensuring coordinated treatment for many patients across the continent. It stands out as the largest fully integrated renal company, providing not only dialysis services but also specialty pharmacy and laboratory services. Additionally, Fresenius manufactures and distributes a wide range of dialysis equipment, disposable products, and renal pharmaceuticals. The goal of Fresenius Medical Care is to enhance the quality of life for patients with chronic illnesses by providing comprehensive and accessible healthcare solutions.

Waltham, MassachusettsHeadquarters

1996Year Founded

$39.1MTotal Funding

LATE_VCCompany Stage

Biotechnology, HealthcareIndustries

11-50Employees

Benefits

Professional Development Budget

Conference Attendance Budget

Flexible Work Hours

Risks

Increased competition from telehealth solutions like Philips' eCareManager 4.1.

Rising mental health challenges may impact FMCNA's employee productivity.

Virtual reality education may face adoption and accessibility challenges in rural areas.

Differentiation

FMCNA is the world's largest fully integrated renal company.

FMCNA offers a comprehensive line of dialysis equipment and renal pharmaceuticals.

FMCNA provides coordinated healthcare services at pivotal care points for chronic conditions.

Upsides

Telehealth market growth supports FMCNA's remote patient monitoring services.

Home dialysis market expansion aligns with FMCNA's patient-centric care approach.

AI integration enhances FMCNA's predictive analytics and personalized medicine capabilities.

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