Managed Care Analyst

Position: Managed Care Analyst I
Under direction of the Manager, the Managed Care Analyst I will be responsible for identifying payment variances, collecting underpayments from third party payers, and notifying management when over payments are detected. Will also be responsible for identifying payment trends, calculating impact and reporting findings to manager. Will interact with Mass General Brigham Finance staff and payor liaisons to understand root causes and make recommendations for resolution that will maximize future reimbursement.

Education

• Bachelor's Degree Related Field of Study required

Experience

• Experience in accounting or finance 3-5 years required

• Experience in a role within a large healthcare organization 3-5 years preferred

Knowledge,

Skills and Abilities

• Possess strong interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization

• Ability to successfully interact and collaborate with others of different skill sets, backgrounds and levels within and external to the organization

• Knowledge of Third Party billing rules and reimbursement methodologies

• Strong financial analytical, problem solving and negotiation skills

• Ability to effectively conduct meetings, both formal and informal

• Proficient with Excel, Access a plus

• Experience with contract modeling tool (Fin Thrive or Experian a plus)

Essential Functions

• Use/s the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done:
Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other:
Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration

• Independently and accurately, analyze third party payment variances and determine root causes for discrepancies, utilizing database tools in a timely manner

• Resolve underpayment variances directly with payors when indicated

• Provide qualitative reporting to manager on over payments

• Provide continuous feedback to manager

• Participate in payor operations and revenue analyses meetings internally and externally as necessary

• Compile summary variance reports for Management

• Act as liaison between Payer Variance team and our zero balance vendors - responsibilities may include, but are not limited to, contract research, payer escalations, invoice management, etc.

• Actively participate in process improvement initiatives including, but not limited to the MGB RCO 'ESP - Everyone Solves Problems' initiative

• Other duties as assigned

Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.

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