Managed Care Contracts Analyst

Position Summary :

The Managed Care Contract Reimbursement Manager serves as the conduit for Managed Care payer related issues with the contracted third-party payers. This position is responsible for organizing, understanding, and managing the managed care contracts. These responsibilities will be achieved by creating and maintaining a database of all managed care contracts and associated insurance plans and understanding and interpreting the payer contract language and fee schedules. This position will oversee contract details and be knowledgeable about major provisions of agreements as they relate to day-to-day operations.

Duties :

• Loads contracts and fee schedules into the contract management system per the agreed reimbursement verbiage.
• Validates expected reimbursement outcomes reported by the contract management system.
• Assists with contract negotiations, modeling proposed rate changes as needed.
• Develops financial models to track and monitor receivables in order to respond quickly to negative changes and enhance positive factors.
• Performs internal audits to verify contracted rates are paid by health plan.
• Conducts analysis of variance for inpatient and outpatient receivables.
• Resolves claim variances by directing workflow for manual intervention to the collections department, personally assisting as needed.
• Works and builds relationships with health plans to address and resolve external root causes to issues / variances.
• Understands and can verbalize VBP goals / targets.
• Consistently participates in the unit and hospital specific action plans to improve HCAHPS scores.
• Is able to use AIDET.
• Understands is individually accountable for achieving Core Measures, HCAHPS and other VBP goals.
• Reports to work on time and as scheduled, completes work within designated time.
• Attends staff meetings and actively participates, reads and returns all staff meeting minutes.
• Actively participates in performance improvement and continuous quality improvement (CQI) activities.
• Demonstrates an understanding of the procedures for reporting and responding to facility emergencies such as fire, and disruption in utilities and hazardous materials spills.
• Demonstrates knowledge of equipment capabilities, limitations, and appropriate / special applications.
• Demonstrates the ability to access and use computer systems.
• Communicates with physicians, administrative staff, co-workers, and patients / families in a respectful and caring manner.
• Demonstrates a positive professional image; performs responsibilities in a professional manner;
• demonstrates flexibility in the provision of patient care / service; utilizes a collaborative approach with co workers.
• Demonstrates flexibility in the work setting with changing assignments, varying staffing levels and
• patient care environments, and completes work on time.
• Consistently demonstrates critical thinking and problem solving skills.
• Assists department management in the resolution and evaluation of problem situations.
• Assumes other duties as required.

Total

100%

JOB QUALIFICATIONS

Minimum Education (Indicate minimum education or degree required.)

Preferred Education (Indicate preferred education or degree required.)

Minimum Work Experience and Qualifications (Indicate minimum years of job experience, skills or abilities required for the job.)

Preferred Work Experience and Qualifications (Indicate preferred years of job experience, skills or abilities required for the job.)

Required Licensure, Certification, Registration or Designation (List any licensure or certification required and specify name of agency.)

Full-Time, Exempt