Managed Care Analyst, Hospital Financial Operations

Community Hospital Corporation•Plano, TX

9h•Onsite

About The Position

Community Hospital Corporation (CHC) is seeking a Managed Care Analyst to support the Vice President of Health Plan Contracting. This role provides analytical and contracting support through health plan contract process management, review, and negotiation. The position operates at the intersection of healthcare finance, insurance claims operations, and legal contract management. The analyst will also support the CHC Revenue Cycle Team and affiliated facilities in analyzing patient account receivables (A/R). This is an onsite role at CHC's corporate offices in Plano.

Requirements

BBA or BS Degree
Five or more years experience in healthcare financial operations.
Experience working with hospital Electronic Health Records (EHR) and billing systems (e.g., Epic, Cerner, Meditech).
Ability to define and prioritize specific realistic, goals and objectives
Ability to identify, analyze and effectively resolve operational and administrative problems
Ability to work independently and manage multiple projects simultaneously
Ability to be trustworthy
Ability to professionally and successfully interact with a variety of internal and external parties
Communicates openly and in a timely way
Shares information appropriately
Keeps others well informed
Responds in a timely manner to messages/requests
Knowledge of hospital revenue cycle and the impact of such operations on hospital reimbursement
Knowledge of hospital and physician health plan contracts, and the impact of such contracts on hospital operations
Knowledge of all types of healthcare payer sources such as commercial, governmental, workers compensation and others
Proficient understanding and application of the concepts and terminology unique to the healthcare industry
Understanding of electronic files; 837, 835, 277
Understanding of the complete revenue cycle process and the financial implications.
Understanding of Protected Health Information (PHI), along with HIPAA HITECH rules and regulations.
Intermediate level user of Excel and/or Google Sheets

Nice To Haves

Health plan contracting experience preferred.
Medicare and Direct Data Entry (DDE) experience preferred, not required
SQL Report Writing Skills preferred

Responsibilities

Review health plan contracts and identify desired contract modifications in accordance with CHC contract criteria.
Assist in negotiations with payers regarding terms and rates and prepare contracts for final signature.
Audit payments received from managed care companies to ensure accuracy at each hospital against contract terms.
Assist in the maintenance of various databases of contract information.
Interact with client hospitals and health plan representatives to ensure claims payment accuracy.
Identify, investigate, and audit claims variances where actual payer reimbursement does not match the expected contractual amount.
Collaborate with the revenue cycle team to resolve complex claims issues and resubmit corrected claims or appeals.
Work in multiple systems for the hospital and clinic settings to provide the support requires the understanding of each facility's financial data points.
Support the CHC Revenue Cycle team with understanding the functionality of claim systems and the associated analytic tools.
Uphold and support the company’s mission, vision, and values.
Perform other miscellaneous job-related duties as assigned by the Vice President of Health Plan Contracting.