Job Summary
Provide subject matter expertise to the Clinical Integration Division, Finance Division, Leadership, and management. Provide statistical data analysis from multiple sources that supports Clinical Integrations strategies as well as Corporate HealthCare Cost initiatives.
Support provider negotiations. Perform duties with minimal management direction and oversight.
Minimum Qualifications
- Bachelor's degree and four years of related work experience; or an equivalent combination of education and related work experience.
- Demonstrated budgeting, forecasting, and variance analysis skills
- Demonstrated working knowledge of managed care / health care business processes, systems and application for claims payment, network, and provider contract administration.
- Demonstration project management skills
- Basic knowledge of Microsoft Office applications. Including but not limited to Word, Outlook, and Power Point.
- Advanced working knowledge of Microsoft Excel.
Duties and Responsibilities
- Design, develop and implement standard plan or provider financial and operational reports in response to customer requirements and business needs
- Lead and implement internal controls; facilitate definition of data and other information requirements; define efficient data assembly methods;
and maintain adequate documentation for general reference and audit purposes.Interpret data and develop reports to communicate findings to senior management.
Participate in project workgroups; facilitate definition of project requirements and deliverables; influence the progress of team activities and the successful implementation of the project.
Document and share project activities, analyses, and decisions.Develop, analyze, recommend, and enhance workflow processes related to project deliverables.
Evaluates alternative solutions / decision in light of the potential impact on internal / external resources; understand the resource implications of solutions and makes other recommendations;
communicate status and recommendations to management.Gather data post-implementation to measure outcomes and impacts.
Develop, analyze, recommend, and monitor reimbursement and provider strategies; prepare reports that measure the effectiveness of reimbursement and contracting terms and the influence they may have on overall program / plan cost and utilization.
Analyze data and identify trends, patterns, or other notable issues with an eye for cost reduction opportunities.Monitor market trends to identify emerging opportunities or risks in business environments.
Monitor various websites for reimbursement and policy changes, focusing on Government entities; make recommendations for implementation of changes.
Communicate with various stakeholders, including physicians, hospital admin staff, other healthcare insurers, auditors, and other departments within the company.
Annual review of compliance workflows, such as, SSAE, MAR.
Actively participate in current audits; be able to respond comprehensively to auditor inquiries.Review provider contracts and ensure that claims system set ups accurately reflect fully executed, signed agreements.
- Respond to ad-hoc data requests from management, executive staff, and external departments.
- Performs all other miscellaneous responsibilities and duties as assigned or directed
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