Analyst Managed Care

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Job Type : Regular

Scheduled Hours : 40

Job Summary :

The overall goal of the Managed Care Dept. is to maximize system revenue from the third-party Medicare, Medicaid and Commercial payers. The Managed Care Analyst assists the VP, Managed Care in contract negotiation and administration. He / she is considered the subject matter expert on all contractual and financial terms of the relationships with the system's payer partners.

Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

Job Description :

• Along with the VP, Managed Care, assists in all contract negotiation to ensure revenue targets are met or exceeded while mitigating contracting and pricing risks.
• Maintains Health Plan Administrative Manuals, contract rate sheets, and contract files.
• Along with the Director, CDM, ensures that annual CDM update process is modeled to produce the desired net effect on annual revenue.
• Assist with operationalizing of contracts & training of operational staff, production of contract non-compliance reports.
• Provides weekly / monthly / quarterly reports, production of variance trend reports noting negative payment trends from third party.
• Works with Patient Financial Services to create timely resolution of all billing errors that create reimbursement errors.
• Works with Director of Patient Financial Services to target payment accuracy of 90+%.
• Performs other duties as assigned.

Education, Credentials, Licenses :

Specialized Knowledge :

Kind and Length of Experience :

FLSA Status : Exempt

Right Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community.