Managed Care Analyst

Summary

• Responsible for loading, modeling, support and maintenance of the managed care contracts and fee schedules within the contract management system, including both Hospital and Professional agreements.
• Participates in contract modeling and other financial analysis using significant amounts of data that must be interpreted to inform decision‑making by the managed care contracting and operations teams.
• Requires a deep understanding of healthcare reimbursement for hospitals and medical groups, contract negotiation concepts, financial analysis, and functionality of contract management databases.
• Works closely with Managed Care, Patient Financial Services, Revenue Integrity, Business Intelligence, and Meritas Business Office.

• Minimum 2 years of experience in a Health System or Managed Care Organization (MCO), with demonstrated experience in healthcare analytics.
• Demonstrated experience in problem‑solving and project management.
• Experience with contract management and modeling software, managed care principals, hospital and professional coding, reimbursement, and financial terms such as DRG, CPT, HCPCS, ICD‑10, APC, ASC groupers, charge master, revenue codes and payor policies preferred.
• Experience with Cerner Patient Accounting preferred.

• Highly skilled in data collection, data analysis (Power BI), advanced Excel knowledge (including pivot functionality and advanced formulas), and relational databases.
• Experience with database extraction of patient accounting, medical records, and patient healthcare record data.
• Knowledge of hospital and physician reimbursement methodologies (i.e. DRG, per diem, fee schedule, APC).
• Working knowledge of billing/coding terminology (i.e. ICD‑10, CPT, Revenue codes).

• Excellent organization and attention to detail are required.
• Ability to communicate complex information to various audiences.
• Able to work in a fast‑paced environment.
• Problem solve issues where analysis is required; decisions and actions have a direct impact on hospital financials.
• Works independently, and as part of a team.
• Multitask and prioritize multiple tasks to meet deadlines.
• Takes ownership of the job, and proactively responds to commitments.
• Takes specific actions to improve own work methods or systems.
  
  Develops and implements new and unique ideas.

Preferred: CCS (Certified Coding Specialist)

Required:

Bachelors - Business, Bachelors - Finance, Bachelors - Accounting, Bachelors - Health Care Management