Managed Care Contracts Sr Analyst

Managed Care Contracts, Sr Analyst

Responsibilities include complex data and financial analysis, financial interpretation of contract terms, contract modeling, data validation, developing reimbursement methodologies, maintaining contracts in EPIC and identification of revenue enhancing opportunities. Develop alternative financial proposals that are within the budget parameters, based on analysis and modeling of contract performance by developing and preparing revised models using sound rationale, and present recommendations to Managed Care leadership. Support the organization by providing ad-hoc detailed data reports related to Managed Care agreements and Patient Financial Services activity to internal and external customers.

• Collaborate with other departments to prioritize and ensure Managed Care contract performance and all related analytic needs are met for the system. Serve as a mentor to other Analysts on the team and a subject matter expert to other CHST departments.
• Complete financial impact analysis of all contract negotiations, including modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of these proposals for future year(s) and developing alternative proposals within the budget parameters. Present analysis and recommendations to leadership.
• Prepare multiple analyses and presentations by extracting data from systems including Crystal, EPIC, STRATA and other Children's Health Services of Texas (CHST) systems and relational databases utilizing expertise in Excel. Evaluates the need to create new or modify existing ad hoc and / or customized reports.
• Review all Managed Care contracts and amendments as received and complete require system updates, ensuring that all contracts in EPIC are current and calculating correctly.
• Analyze contracts and prepare all supporting schedules necessary to update / maintain the EPIC system on a current basis. This includes but not limited to : reviewing all new contracts / amendments, meeting with Revenue Cycle staff to review changes, communicating with the payors to receive all updates on current basis, researching and downloading data form payor sites, analyzing and comparing new fee schedules to the prior fee schedules, preparing all uploads, validating input and updating EPIC reimbursement contracts.
• Stay abreast of all Texas Medicaid & Healthcare Partnership (TMHP), CMS and other governmental regulation changes that affect Fee Schedule pricing. Proactively model all changes to fee schedules to determine the financial impact on CHST revenue and communicate with leadership.
• Accountable for the maintenance of the Payor and Plan database in EPIC. Facilitate monthly meetings and seek agreement before any changes are made. Maintain the synchronization among the service areas. Ensure all plans are mapped to correct contract in EPIC and facilitate audits, at least on a quarterly basis.
• Interprets managed care contract terms and validates understanding with the contract negotiator and model relevant parameters into contract model application for contracts with annual revenue in excess of $2.3 Billion.
• Accountable for contract model module and / or application, including but not limited to the maintenance of commercial and government Managed Care Organization (MCO) contracts, fee schedules and other tables relating to contract modeling generating annual CHST revenue of in excess of $1.5 Billion.
• Actively participates on cross functional teams to identify revenue enhancement opportunities and develop and implement solutions for under-performing facility and professional contracts, including improvements in denials and underpayments. Provides necessary reporting and analytics to support the goals of these teams.
• Communicates difficult and / or sensitive and confidential information. Handles confidential material on a regular basis and is responsible for protecting the confidentiality of such information within the established guidelines of CHST and law.
• Supports the Senior Director, Managed Care with existing and new projects / initiatives.
• Works in a fast-paced environment with frequently changing priorities.
• At least 5 years experience in financial analysis, data mining and reporting Required
• At least 5 years experience with hospital billing system, EPIC Preferred
• At least 5 years experience in Healthcare, contract modeling and analysis for facility and professional agreements Preferred
• Four-year Bachelor's degree or equivalent experience Required
• Epic certification within one year of hire 1 Year Required

We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.

Holistic Benefits How We'll Care for You :

Employee portion of medical plan premiums are covered after 3 years.

4%-10% employee savings plan match based on tenure

Paid Parental Leave (up to 12 weeks)

Caregiver Leave

Adoption and surrogacy reimbursement

As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.