Managed Care Analyst

Overview

Managed Care Analyst

As Mount Sinai grows, so does our legacy in high-quality health care.

Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24 / 7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.

Culture of Caring : The Sinai Way

Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.

Responsibilities

• Possess understanding of managed care payment methodologies to effectively analyze managed care trends and contract performance.
• Analyzes large healthcare datasets, including patient records, insurance claims, and financial reports, to identify trends and ensure payer compliance.
• Develops and provides regular reports on the financial performance of managed care contracts to support negotiations, budgeting, and long-range planning.
• Communicates findings, analyses, and recommendations to managed care leadership and collaborates with business office personnel.
• Conducts research and provides data to support the negotiation of payment rates and terms with managed care companies and health plans. This includes, but is not limited to, preparation of the Negotiation Packet based on the Negotiation Checklist.
• Possess a comprehensive understanding of healthcare data sources (e.g., CMS plan and quality files, OIR HMO reports, hospital / plan transparency) to produce data for managed care and population health analysis.
• Utilize EPIC reporting tools, SAP, and other systems to extract and analyze data for managed care and population health reporting.
• Compile, maintain and distribute routine operational reports, such as Volume and Plan Enrollment in a timely manner.
• Coordinates the submission process for all health plan quality and performance programs, ensuring timely and accurate completion.
• Proactively track changes and updates to health plan policies, procedures, and products by regularly monitoring websites, newsletters, and other official communications. Analyze the potential impact of these changes on the medical center's operations and provide detailed analysis to inform internal communications for the revenue cycle team.
• Independently manages the retrieval and analysis of data on multiple tasks or projects, to timely project completion.
• Prepare graphic representations of results and make presentations to management and others, as needed.
• Possess extreme attention to detail and follow through skills. Includes formatting of reports, headers / footer use and accuracy, timeliness.

Benefits

We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs. Our robust employee benefits package includes :

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