Managed Care Contracting Analyst

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

📋 Description

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

• Pinpoint opportunities for performance enhancement.

• Evaluate Medicaid and other managed care offerings, such as HMO, PPO, and POS products.

• Track and analyze third-party reimbursements and conduct denial assessments.

• Develop financial models and comprehensive reports.

• Assist management by sourcing and gathering data under tight deadlines.

• Identify utilization trends impacting healthcare expenses and suggest actions to enhance financial outcomes.

• Review shared-risk claims, capitation agreements, risk-pool settlements, and reports from health plans.

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

• Generate reimbursement reports for payors intended for senior leadership.

• Advise on utilization-related application modifications for the Revenue Cycle.

• Extract and analyze financial and claims data to develop analytical and statistical models.

• Detect and communicate trends and potential concerns to management.

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

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

• Assess health-payor optimization in each market.

• Organize and schedule Joint Operating Committees (JOCs) with relevant health-plan representatives.

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

• Retrieve and analyze data from various sources and systems, compiling written and verbal reports and presentations.

⛳️ Requirements

• High school diploma or equivalent.

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

• At least three years of experience in an analytic or analyst position within a healthcare setting.

• Comprehensive understanding of physician reimbursement practices.

• Experience with relational databases, decision support systems, analysis, and modeling.

• Two or more years of experience in Revenue Cycle Billing.

• Familiarity with the payor reimbursement process.

• Proficient knowledge of computer systems.

• Understanding of Health Plan Billing claim documentation and timelines.

• Awareness of Health Plan Billing regulations and timelines.

• Ability to cultivate strong working relationships with both internal and external stakeholders.

• Effective communication skills with staff, leadership, health plan representatives, and other departments.

• Strong organizational skills to manage daily work activities and projects efficiently.

• Capable of exercising independent judgment and decision-making.

• Must read and sign the CORE Creed.

• Compliance with OSHA requirements and safety training.

🏝️ Benefits

• Full-time employment.

• OSHA safety training provided.

• CORE Creed must be read and signed.