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, taking into account regulatory rate adjustments and other changes.

• Detect performance challenges and propose areas for enhancement.

• Examine Medicaid and various managed care products, including HMO, PPO, and POS offerings.

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

• Develop financial models and reports to address current and future reporting requirements.

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

• Analyze utilization trends that influence healthcare costs and suggest actions to enhance financial outcomes.

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

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

• Generate payor reimbursement reports for senior management.

• Suggest modifications in application usage to the Revenue Cycle.

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

• Recognize and relay trends and potential issues to management.

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

• Work in collaboration with Contracting/Credentialing to maximize health payor reimbursement.

• Analyze health payor optimization across various markets.

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

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

• Extract and query data from multiple 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.

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

• Comprehensive understanding of physician reimbursement methodologies.

• At least two years of experience with Revenue Cycle Billing.

• Proficient in utilizing relational databases, decision support systems, and analytical modeling.

• Familiarity with the payor reimbursement processes.

• Knowledge of various computer systems.

• Understanding of Health Plan Billing claim documentation and timelines.

• Awareness of Health Plan Billing timelines and regulations.

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

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

• Capacity to organize and efficiently manage daily tasks and projects.

• Ability to exercise independent judgment and make decisions.

• Capability to meet stringent deadlines.

• CORE Creed must be read and signed.

• Compliance with OSHA requirements and training, including safety training.

🏝️ Benefits

• Full-time employment.

• CORE Creed must be read and signed.

• OSHA safety training.