Managed Care Contracting Analyst

Healthcare Outcomes Performance Company•Phoenix, AZ

2d•Onsite

About The Position

This role involves preparing analysis related to the financial and operational performance of health care contracts, including the impact of regulatory rate or other changes. The analyst will identify the financial and/or operational performance of agreements and recommend areas for improvement. The position supports management by providing information, locating data sources, and collecting data under tight time constraints. The analyst will also identify and analyze utilization patterns driving healthcare costs, recommend actions to impact financial performance, and review shared risk claims, capitation, risk pool settlements, and reports submitted by health plans. The role requires submitting shared risk discrepancy reports within specified time limits and formats. Additionally, the analyst will create various reports regarding payor reimbursement for Senior Leadership, provide recommendations to Revenue Cycle regarding changes in utilization of applications, and create queries to pull financial/claims data for analytical and statistical models. The job holder must demonstrate current competencies for the job position.

Requirements

High school graduate or equivalent.
Minimum of three years’ experience working in analytic or analyst role in a healthcare environment with an in depth knowledge of physician reimbursement.
Experience in using relational databases, decision support systems, analysis and modeling.
Two or more years’ experience with Revenue Cycle Billing.
Knowledge of the Payor Reimbursement process.
Knowledge of computer systems.
Knowledge of Health Plan Billing claim paperwork and timelines.
Knowledge of Health Plan Billing timelines and regulations.
Skill in establishing good working relationships with internal and external customers.
Skill in organizing daily work assignments for various tasks.
Skill in managing multiple work assignments and set priorities.
Skill in meeting demanding deadlines.
Ability to establish good working relationships with internal and external customers.
Ability to communicate effectively with staff, leadership, health plan representatives, other depts.
Ability to be organized and efficient in daily work activities/projects.
Ability to exercise independent judgment and decision-making abilities.

Nice To Haves

Bachelor’s Degree in Finance or Healthcare Administration preferred.

Responsibilities

Prepare analysis related to the financial and operational performance of health care contracts, including the impact of regulatory rate or other changes and identify the financial and/or operational performance of those agreements. Recommends areas of improvement.
Provides analysis for Medicaid and other Managed Care products such as HMO, PPOs and POS products.
Monitor and trend third party reimbursement including denial analysis.
Create financial models as required to analyze data and report efficiently for existing and new reports.
Supports Management by providing information, locating data sources and collecting data under tight time constraints.
Identify and analyze utilization patterns driving health care costs and recommend actions to impact financial performance.
Reviews all shared risk claims, capitation, risk pool settlements, and various reports submitted by the health plans. Submit shared risk discrepancy reports within the time limits required by each individual health plan and in the format requested by each individual health plan.
Create various reports regarding payor reimbursement for Senior Leadership.
Charged with providing recommendations to Revenue Cycle regarding changes in utilization of those applications.
Create queries to pull financial/claims data that will then be used to develop analytical and statistical models to help customers make informed business decisions.
Identifies and communicates trends and//or potential issues to management team.
Serves as the liaison between health plans and revenue cycle.
Collaborates with Contracting/Credentialing Dept to optimize health payor reimbursement outcomes.
Analyze health payor optimization within each market.
Create and schedule JOCs with each applicable health plan rep for each market.
Updates & Audits Clearwave system to ensure provider information is most current.
Extracts and queries data from multiple sources and systems and compile data in the form of written and verbal reports and presentation.