Managed Care Analyst II

Position Summary

Remote not available in all states.

The Managed Care Analyst II will provide analytical and technological support and development of systems and processes to aid managed care negotiations, financial management, compliance and monitoring to ensure achievement of established financial /strategic goals. This position is required to fully understand and apply all elements from the Contract Exhibit Reimbursement, and build and maintain those terms in the EPSI Contract Module.

This position is also responsible to build and distribute both canned and ad-hoc reports in timely manner and to design meaningful summaries to aid in the decision process. This position reports to the Manager of Reimbursement and Managed Care Analytics

• Bachelor’s Degree in Business Administration, Accounting, Finance, Information Systems or related field or 5 years relevant experience working in a hospital or managed care payer setting. (Required)

• Three years of experience in health care financial systems within a hospital or health plan/insurance environment. (Required)
• Experience with managed care principals, business models, hospital and professional coding, reimbursement and financial terms such as DRG, CPT ICD9-10 and HCPCS codes and standard reimbursement payment methods (Required)
• Experience with database concepts and MS Access. (Required)
• Experience with various business intelligence and performance management tools such as Crystal Reports or SQL Visual Studio. (Preferred)

• Proficient in MS Excel in the use of advance pivot functionality, statistical models, and advanced formulas. (Required)
• Experience with health services billing procedures (hospital and professional) and reimbursement methodologies. (Required)
• Experience with Misys, Eclipsys AMPFM, EPSI PLA and Contract Module or other decision support, contract modeling and financial reporting systems. (Preferred)