Managed Care Contracting Analyst

Job Description:

• Prepare analyses of the financial and operational performance of healthcare contracts, including regulatory rate and other changes
• Identify performance improvement opportunities
• Analyze Medicaid and other managed care products, including HMO, PPO, and POS products
• Monitor and trend third-party reimbursement and perform denial analysis
• Create financial models and reports
• Support management by locating data sources and collecting data under tight time constraints
• Identify utilization patterns driving healthcare costs and recommend actions to improve financial performance
• Review shared-risk claims, capitation, risk-pool settlements, and health-plan reports
• Submit shared-risk discrepancy reports according to health-plan deadlines and formats
• Create payor reimbursement reports for senior leadership
• Recommend utilization-related application changes to Revenue Cycle
• Query financial and claims data to develop analytical and statistical models
• Identify and communicate trends and potential issues to management
• Serve as liaison between health plans and Revenue Cycle
• Collaborate with Contracting/Credentialing to optimize health-payor reimbursement
• Analyze health-payor optimization within each market
• Create and schedule JOCs with applicable health-plan representatives
• Update and audit the Clearwave system to maintain current provider information
• Extract and query data from multiple sources and systems, compiling written and verbal reports and presentations

Requirements:

• High school graduate or equivalent
• Bachelor’s Degree in Finance or Healthcare Administration preferred
• Minimum of three years’ experience working in an analytic or analyst role in a healthcare environment
• In-depth knowledge of physician reimbursement
• Experience 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
• Ability to establish good working relationships with internal and external customers
• Ability to communicate effectively with staff, leadership, health plan representatives, and other departments
• Ability to organize and efficiently manage daily work activities/projects
• Ability to exercise independent judgment and decision-making
• Must read and sign the CORE Creed
• OSHA requirements and safety training

Benefits:

• Full-time employment
• OSHA safety training
• CORE Creed must be read and signed