Analyst-Mgd Care Reimbursement

Northeast Georgia Health System

About The Position

Performs a wide range of complex managed care analytical and operational functions. Performs office procedures in support of managers. This position is responsible for managed care financial analysis. This person will also assist with contract negotiation processes as needed, make recommendations to the Managed Care negotiators regarding terms of the contract. This person will act as a liaison between contract management system administrators, Revenue Cycle, and the Managed Care negotiators for resolution and feedback of any related items. This person will work with managed care payors to resolve claims and related issues in order to enhance managed care contract performance.

Requirements

High School Diploma or GED.
Four (4) years of related managed care contracting and/or billing/collection experience in a hospital and/or managed care payor setting.
Knowledge of Microsoft Excel and other spreadsheet systems
Knowledge of the Patient Accounting Systems.
Knowledge in Managed Care or similar reimbursement area
Knowledge of SQL programs, understanding of billing practices, specifically revenue codes, CDM codes, and ICD-9 codes
Excellent organizational and communication skills
Must have knowledge of contract negotiation process
Must be able to apply mathematical and analytical skills
Exemplifies the organization's customer service standards
Improves work processes
Meets all mandatory educational requirements
Complies with confidentiality rules, polices, and regulations in all aspects of the job
Demonstrates working knowledge of safety practices
Promotes teamwork
Meets NGHS attendance standards
Utilizes financial resources effectively
Responds positively to change regarding work
Demonstrates respect for co-workers

Responsibilities

Able to understand and interpret Managed Care Contracts.
Ability to accurately update the Managed Care Systems, and when required, the Business Office Legacy System.
Pursue payment from payers.
Customer Service/Continuous Improvement.
Posses a specific knowledge of Third Party Healthcare Arrangements and is able to apply that knowledge.
Must be able to calculate and audit expected reimbursement in order to determine accuracy of payment.
Must be willing to learn and act as a “System Administrator.”
Must be able to make the appropriate payment classifications determination and record it accurately in the system.
Continually seeks ways and means for improving the delivery and support of Managed Care Modeling & Reimbursement System feedback.
Is aware of process flow(s) across all Revenue Cycle departments, and involves them, as appropriate, when recommended actions may impact their work functions.