Managed Care Contracting Analyst

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Conduct analyses of the financial and operational performance of healthcare contracts, including changes in regulatory rates or other factors.

• Detect performance issues and suggest areas for enhancement.

• Provide analytical support for Medicaid and various managed care products, such as HMO, PPO, and POS plans.

• Monitor and analyze third-party reimbursements, including denial assessments.

• Develop financial models and reports to address both existing and emerging reporting requirements.

• Assist management by identifying data sources and gathering information under tight deadlines.

• Analyze utilization trends influencing healthcare costs and propose strategies to enhance financial performance.

• Review shared-risk claims, capitation, risk-pool settlements, and health-plan reports.

• Prepare shared-risk discrepancy reports in accordance with health-plan deadlines and specified formats.

• Generate payor reimbursement reports for senior management.

• Recommend modifications in application utilization to the Revenue Cycle.

• Create queries to extract financial and claims data for analytical and statistical purposes.

• Identify and relay trends and potential issues to management.

• Act as a liaison between health plans and the Revenue Cycle.

• Collaborate with Contracting/Credentialing to enhance health-payor reimbursement outcomes.

• Analyze health-payor optimization strategies within each market.

• Organize and schedule Joint Operations Committees (JOCs) with relevant health-plan representatives for each market.

• Update and audit the Clearwave system to ensure accurate provider information.

• Extract, query, and compile data from various sources into written and verbal reports and presentations.

⛳️ Requirements

• High school diploma or equivalent qualification.

• Bachelor's Degree in Finance or Healthcare Administration is preferred.

• A minimum of three years’ experience in an analytic or analyst position within a healthcare setting.

• Comprehensive knowledge of physician reimbursement processes.

• At least two years’ experience in Revenue Cycle Billing.

• Proficiency in utilizing relational databases, decision support systems, and analysis and modeling techniques.

• Familiarity with the Payor Reimbursement process.

• Understanding of computer systems.

• Knowledge of Health Plan Billing claim documentation and timelines.

• Awareness of Health Plan Billing regulations and timelines.

• Strong ability to build effective working relationships with both internal and external stakeholders.

• Excellent communication skills to interact with staff, leadership, health plan representatives, and other departments.

• Ability to maintain organization and efficiency in daily tasks and projects.

• Capacity to exercise independent judgment and make decisions effectively.

• The Core Creed must be read and acknowledged.

• Comply with OSHA requirements and undergo safety training.

🏝️ Benefits

• Full-time employment.

• Standard office environment.

• OSHA safety training.