Analyst Managed Care
About The Position
The overall goal of the Managed Care Dept. is to maximize system revenue from the third-party Medicare, Medicaid and Commercial payers. The Managed Care Analyst assists the VP, Managed Care in contract negotiation and administration. He/she is considered the subject matter expert on all contractual and financial terms of the relationships with the system’s payer partners. Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background. Along with the VP, Managed Care, assists in all contract negotiation to ensure revenue targets are met or exceeded while mitigating contracting and pricing risks. Maintains Health Plan Administrative Manuals, contract rate sheets, and contract files. Along with the Director, CDM, ensures that annual CDM update process is modeled to produce the desired net effect on annual revenue. Assist with operationalizing of contracts & training of operational staff, production of contract non-compliance reports. Provides weekly/monthly/quarterly reports, production of variance trend reports noting negative payment trends from third party. Works with Patient Financial Services to create timely resolution of all billing errors that create reimbursement errors. Works with Director of Patient Financial Services to target payment accuracy of 90+%. Performs other duties as assigned.
Requirements
- Bachelor’s degree in finance/accounting or commensurate industry experience in dealing with third-party payers is required
- Microsoft Office Software, Word, Excel, Access
- Understand third party contractual relationships
- 3 years’ experience including: general accounting, financial analysis; hospital billing, registration systems, and oral and written communication skills
Responsibilities
- Assists in contract negotiation
- Maintains Health Plan Administrative Manuals, contract rate sheets, and contract files
- Ensures that annual CDM update process is modeled to produce the desired net effect on annual revenue
- Assist with operationalizing of contracts & training of operational staff, production of contract non-compliance reports
- Provides weekly/monthly/quarterly reports, production of variance trend reports noting negative payment trends from third party
- Works with Patient Financial Services to create timely resolution of all billing errors that create reimbursement errors
- Works with Director of Patient Financial Services to target payment accuracy of 90+%
- Performs other duties as assigned
Benefits
- Competitive pay and comprehensive health coverage within the first 30 days.
- Generous paid time off and flexible work schedules
- Retirement savings with employer match
- Tuition reimbursement and professional development opportunities
- Wellness, mental health, and recognition programs
- Career advancement through mentorship and internal mobility
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
