Contract Analyst (Managed care)
About The Position
NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone the No. 1 comprehensive academic medical center in the country for three years in a row, and U.S. News & World Report recently placed nine of its clinical specialties among the top five in the nation. NYU Langone offers a comprehensive range of medical services with one high standard of care across 6 inpatient locations, its Perlmutter Cancer Center, and over 320 outpatient locations in the New York area and Florida. With $14.2 billion in revenue this year, the system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise with over $1 billion in active awards from the National Institutes of Health. In this role, the successful candidate as the Contract Analyst is responsible for organizing and reviewing financial and utilization data and hospital billing data. This position is responsible for creating and analyzing profit and loss reports and other managed care reports from the cost accounting system. The incumbent will create managed care reports with detailed financial utilization data from other data sources. Additional responsibilities include reviewing all managed care contracts and addressing changes that impact these contracts, validation of contract compliance and other provisions of managed care.
Requirements
- Bachelors degree in Business Administration or relevant discipline
- 1-2 years relevant experience or an equivalent combination of education and experience.
- Proficiency using relational databases, database concepts and software applications
- MS Access and Excel knowledge.
- Excellent interpersonal and presentation skills.
- Knowledge of healthcare terms and reimbursement methodologies.
- Strong analytical and problem solving skills.
- Qualified candidates must be able to effectively communicate with all levels of the organization.
Nice To Haves
- Familiarity with Crystal/EPSi reporting and EPIC.
Responsibilities
- Demonstrates knowledge of the organizations Core Values and incorporates them into the performance of duties.
- Organizes and reviews financial and utilization data, including insurer claims, eligibility, hospital billing data, payors physician fee schedules and Medicare RBRVS fee schedule.
- Reviews all managed care contracts; provides analytical support regarding changes impacting contracts, validation of contract compliance and other provisions of managed care.
- Uses EPSI reporting capability of the hospital decision support system to create managed care reports and to generate and analyze profit and loss reports on individual contracts.
- Uses Business objects to run detailed charge level data to accurately model contracts during rate negotiations or identify underpayments issues.
- Assists with loading, auditing and maintaining of payor and physician contracts in EPSI contract modeler in addition to auditing payor contracts loaded in EPIC patient billing system.
- Prepares managed care reports with detailed financial utilization information on a fee-for-service basis by payer, provider type and by specialty.
- Provides assistance to Hospital Finance Department to support financial management and evaluation of fee for service hospital contract and identify methods for improving report efficiency. As well as the FGP and other Hospital department ad hoc reporting.
- Monitors and tracks ongoing claims resolution activities and other practice or hospital service issues that impact reimbursement. Provides log-in access to payor websites by request.
- Assist Managed Care analytics with Contract modeling on a payor by payor basis.
- Perform tasks related to pricing transparency and other government regulatory requirements
- Reviews and identifies yearly CPT coding changes and impact on current contracts
Benefits
- financial security benefits
- a generous time-off program
- employee resources groups for peer support
- holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
