Sr Managed Care Contract and Revenue Cycle Analyst

Job Description

Schedule: FT, Mon - Fri

At Children's, the region's only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team-and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview
The Sr. Managed Care Contract and Revenue Analyst will conduct complex and detailed analysis and modeling of managed care contracts for the organization. This position will develop reports and perform analysis to identify root causes of variances and revenue cycle improvement opportunities. The candidate must possess strong analytical and critical thinking skills. This position will work closely with the Managed Care and Revenue Cycle leadership.

Essential Functions

• Provides analytical support to the Director of Managed Care • Review and project contract performance based on modeling of actual and representative samples. • Gather and interpret data from a variety of sources to provide accurate and complex data analysis supporting annual payor contract negotiations. • Provides analytical support and reconciliation of contract provisions and disputes. • Perform detailed analysis of the financial and operational impact of clinical pathway change within the organization. • Track and monitor payer related issues and communicate to the Director of Managed Care.
• Completes month-end balancing, scheduled month-end reports, scorecards, ad hoc reporting and data analysis as needed to support revenue cycle operations and financial reporting. • Provides detailed measurement & interpretation; prepares analysis of data and presents findings to RCM leadership team and Finance with analyses of revenue cycle operations and financial performance as required. • Provides reports and analysis to identify significant variances to expected performance outcomes & metrics. • Prepares presentations that communicate complex analysis and findings in a concise and interpretable manner to support strategic initiatives. • Performs intermediate to advanced spreadsheet analyses & database solutions using Epic reporting tools and other software such as Excel & MS Access
• Assist with the analysis of accounts receivable financial performance based on analysis of claims processing, payer remittances, payment variances and denials. • Uses the information to analyze and make recommendations for improvements to the RCM leadership team. • Provides support to the CBO HB & PB Denials Management Committees through development and analysis of denial reports and root cause analysis. • Coordinates research, analysis, and remediation of moderately complex data with I.T. which directly impacts the Revenue Cycle and provides recommendations in support of critical business decisions when necessary.
• Performs annual fee schedule analysis to identify opportunities to maximize reimbursement.
• Promote a culture of collaborative, customer-focused service delivery with both internal and external resources.
• Perform physical requirements as described in the Physical Requirements section
• Regular attendance at work is an essential function of the job.

Education Qualifications

• Bachelor's Degree from an accredited college or university in healthcare administration, information systems, finance or related field required, or equivalent work experience. Required

Experience Qualifications

• Minimum 5 years' experience in hospital and physician revenue cycle, billing and collections processes, or healthcare finance. Required and
• Minimum 2 years' experience in analysis of financial, reimbursement, or managed care contract modeling. Required

Skills and Abilities

• Knowledge of revenue cycle functions, reimbursement, billing terminology, and best practices
• Knowledge of internal operations to facilitate appropriate revenue cycle management tactics.
• Knowledge of the current healthcare climate, including HIPAA standards and governmental programs and regulations.
• Knowledge of CPT, HCPCS and revenue codes and their effect on reimbursement.
• Ability to solve complex problems and adapt to process variances in situations where limited standardization exists.
• Ability to communicate effectively both verbally and in writing.
• Ability to complete and analyze data queries, scorecards, detailed statistical measurement and interpretation, and financial forecasts.
• Intermediate to Advanced knowledge of Excel and Word - required

Licenses and Certifications

• EPIC - EPIC Certification in revenue cycle reporting modules Preferred

Children's is the very best for kids and the very best for your career! At Children's, we put YOU first so together, we can improve the life of every child!