This position reports to the Director of Decision Support and Analytics and is responsible for the management and analysis of Managed Care initiatives including the extraction and analysis of data impacting the Managed Care Payor Contracts, (Medicare performance, Medicaid, Managed Care, Commercial), accounts receivable, denials, and payor contract performance. The Managed Care and System Support Analyst will collaborate with other key functions including healthcare center financial, clinical departments, and revenue cycle business services, as well as regional and corporate services. This exciting position may have opportunities to work on emerging Managed Care issues and special projects. This position is also responsible for supporting and ensuring the integrity of data coming into and out of managed care. These tasks can include reconciling data between systems, completing proformas and operational analytics all while maintaining a high level of service for the customer base.
- Implement and document best practice policy and procedures for ad-hoc reporting, validation and all related process essential to creating streamlined managed care and system reporting.
- Supports the Managed Care team in financial analysis and contract improvement
- Participates on special Managed Care projects such as Evaluation of Contract Performance, Budget Analysis, Market Performance, Under payment/Over payment Review
- Extracts and analyzes data from health information, decision support, and EHR systems
- Contribute to system design and integration recommendations for improvement for all used systems
- Provides timely and accurate analysis to enhance revenue cycle process outcomes
- Performs statistical, cost and financial analysis of data extracted from various internal sources. Prepares reports based on findings, including health care costs, provider contracts, revenue and profitability.
- Researches a variety of complex issues impacting Managed Care revenue and recommends processes to enhance financial performance
- Prepares reports evaluating the performance of Managed Care contracts
- Performs research on best practices and national benchmarks for the healthcare industry
- Contributes to the successful implementation of Managed Care projects
- Performs other duties and special projects as assigned
- Bachelors or Masters Degree, preferably in Business or Finance
- Ability to work independently with minimal supervision as well as ability to work in a team environment
- Skilled at managing multiple projects with various customers and grasp new concepts
- Proficient in extracting data from data sources and is detail-oriented
- Strong analytical skills to perform complex analyses
- Possess effective problem solving skills and a positive 'can-do' attitude
- Advanced knowledge of healthcare industry with emphasis on Managed Care contract terminology (i.e., DRG, Per Diem, Case Rate, ICD10)
- Accurately complete assignments while meeting deadlines
- Excellent organizational skills
- Excellent oral and written communication skills
- Ability to interface with all levels of personnel in a large organization
- Proficient in Microsoft Office products including Excel, Word, Power Point, MS Project
- 4 plus years advanced experience in hospital contract modeling
- 4 plus years advanced experience in physician and ancillary contract modeling, (i.e.
- Experience with hospital account reconciliations and reimbursement methodologies
- Ad-Hoc reporting experience with skills in extracting and analyzing appropriate data
- Understanding of revenue cycle operations including high dollar, claim disputes, denials, system logic, and plan edits
- Demonstrated leadership in teamwork, special projects and complex assignments