TheManaged Care Analyst is an integral member of theManaged Care Contracting Team. This position isresponsible for the compilation, validation and analysis of healthcare cost, quality andutilization data, which provides administrative, analytical, negotiation and public relationssupport to the Finance Divisionunder the supervision of the Director of Finance andManaged Care.
*Commits to the mission, vision, beliefs and consistently demonstrates our core values.
*Analyzes and negotiates contract rates with insurance plans.
*Reviews and develops reports, analyzes statistics and prepares a summary of pertinent data to evaluate contracts, which are due for renegotiation, and generates information as requested by other departments.
*Prepares all data necessary to negotiate with payers and other contracted entities (inclusive of patterns in utilization, costs and reimbursement).
*Monitors and analyzes various aspects of contract reimbursement and performs analysis on differences between expected and actual reimbursement.
*Analyzes current reimbursement in relation to cost and identifies opportunities for improved reimbursement.
*Develops proposed and target rates considering profit margin in comparison to other services and other payers, payer denials, polices, and payer market share.
*Models and evaluates counter proposals received from payers. Works with payer to resolve any modeling differences.
*Generates reports used to oversee third party payer activity; researches and corrects any discrepancies; maintains a log of all underpayments and overpayments.
*Provides information regarding payment discrepancies to PFS; participates in activities to identify and resolve patterns of incorrect payments by third party payers; contacts and resolves incorrect payments with payers.
*Analyzes denials and follows up on identified discrepancies; works with other areas to resolve any patterns or issues.
*Creates and/or modifies managed care contracts using programming logic when new contracts or changes occur; ensures accuracy within EPIC.
Bachelor's degree in Business or health related field required. Minimum of six (6) years managed care contracting and/or contract management experience required. Healthcare related experience preferred
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, protected veteran status, or disability status. Bryan Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.
Req # 14979