Managed Care Business Analyst

Nevada System of Higher Education•Arlington Heights, IL

4d•$33 - $49•Onsite

About The Position

This position serves as the key operational contact between contracted payor health plan representatives and Endeavor Revenue Cycle teams. The Managed Care Business Analyst collaborates daily with hospital and physician Revenue Cycle teams, as well as Operational and Clinical Departments to identify and solve trended issues with payors which affect accurate and timely reimbursement. Collaboration, engagement, and on-going, professional pro-active communication with internal stakeholders and payors is essential for success in this role.

Requirements

The minimum educational requirement is a bachelor’s degree, or equivalent work experience.
Two or more years of relevant and/or progressive experience in managed care organization, consulting firm, hospital system and / or hospital.
Proficiency in data analysis required
Microsoft Office, advanced spreadsheet skills
Excellent written and verbal communication skills
Previous revenue cycle experience

Nice To Haves

Four to eight years of relevant experience in a managed care organization, consulting firm, hospital system and / or hospital is preferred.
Epic experience preferred

Responsibilities

Establishes strong collaborative relationships with payor representatives.
Leads monthly meetings between Revenue Cycle teams and payor.
Responds to daily communication from payor and Endeavor stakeholders regarding health plan related issues including claim denials, prior authorization concerns and patient access issues.
Routinely engages with Payor representatives to facilitate collaborative resolution with Revenue Cycle teams.
Supports system wide communication of health plan policies, procedures, and system participation in contracted products and plans.
Updates and shares all tools/documents created by the Payor Relations team that are utilized by Revenue Cycle and Clinical Teams (examples: Pre Certification rules Plan/Product Participation).
Researches and resolves operational issues resulting in nonpayment or denial of payment.
Acts as the second level escalation point for payor related reimbursement and operational issues.
Identifies, analyzes, and communicates key issues/trends. Effectively documents and communicates trended issues and concerns to leadership.
Resolves complex or critical situations involving internal departments and external stakeholders/payors. Works with Revenue Cycle, IT, Utilization Management and Patient Access to implement any major administrative payor requirement that has a material financial impact.