Managed Care Analyst

Bronson Healthcare

83d

About The Position

The Managed Care Analyst is responsible for managing the ongoing review of actual payor payments versus expected payments through the process of routine retrospective auditing of payments. The Contract Audit Analyst develops auditing schedules, tracking mechanisms and coordinates the pursuit of the recovery of net revenue, rebilling of claims and/or settlement opportunities. Through the ongoing auditing process, the Contract Audit Analyst may identify enhancements required to Epic contract models and/or opportunities for education within the Revenue Cycle team as a result of denials trends. The position is responsible for following up with recommendations to change contract models and works collaboratively with the team to enhance processes to minimize denials. A thorough understanding of payor contracts and relevant documents to payor reimbursement, coverage and authorization policies is required. This position manages the Managed Care Payor Contracting database and develops automated reports to generate key terms as required to ensure timely and thorough contract management.

Requirements

• Bachelor’s degree in Finance, Accounting, Business Administration or related field preferred, or 2-3 years of comparable work experience.
• Understanding of billing and reimbursement methodologies and concepts common to payor reimbursement techniques.
• Intermediate Excel skills and Microsoft Office suite proficiency.
• Diagnosis and procedural coding knowledge.
• Excellent customer service skills, both oral and written.
• Ability to negotiate priorities and act on deliverables and timeframes.

Responsibilities

• Manage ongoing review of actual payor payments versus expected payments through retrospective auditing.
• Develop auditing schedules and tracking mechanisms.
• Coordinate recovery of net revenue, rebilling of claims, and settlement opportunities.
• Identify enhancements required to Epic contract models and opportunities for education within the Revenue Cycle team.
• Follow up with recommendations to change contract models.
• Collaborate with the team to enhance processes to minimize denials.
• Manage the Managed Care Payor Contracting database.
• Develop automated reports to generate key terms for contract management.
• Contribute to annual revenue enhancement targets through routine auditing of payer contracts.
• Create routine tracking mechanisms and reporting for payor auditing results.
• Interpret and understand all payer contract documents.
• Assist in the collection, preparation, and analysis of payor fee schedules.
• Maintain the departmental contract management database.
• Act as a back-up for departmental analysis related to payor reimbursement.
• Participate in Epic user payor reimbursement related groups and educational resources.
• Document department procedures to streamline tasks and improve productivity.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees