Community Hospital Corporation (CHC) is looking for a
Managed Care Analyst that will support the Vice President of Health Plan Contracting, providing analytical and contracting support to the Health Plan Contracting function through health plan contract process management, health plan contract review and negotiation. This position sits at the intersection of healthcare finance, insurance claims operations, and legal contract management.
This individual is also responsible for providing analytical support to the CHC Revenue Cycle Team and the CHC affiliated facilities to analyze the patient account receivables (A/R). The position will report directly to the Vice President of Health Plan Contracting.
Major Responsibilities:Health Plan Contracting- Review health plan contracts and identify desired contract modifications in accordance with CHC contract criteria.
- Assist in negotiations with payers regarding terms and rates and prepare contracts for final signature.
- Audit payments received from managed care companies to ensure accuracy at each hospital against contract terms.
- Assist in the maintenance of various databases of contract information.
- Interact with client hospitals and health plan representatives to ensure claims payment accuracy.
Revenue Cycle Analysis- Identify, investigate, and audit claims variances where actual payer reimbursement does not match the expected contractual amount.
- Collaborate with the revenue cycle team to resolve complex claims issues and resubmit corrected claims or appeals.
- Work in multiple systems for the hospital and clinic settings to provide the support requires the understanding of each facility's financial data points.
- Additional responsibilities include supporting the CHC Revenue Cycle team with understanding the functionality of claim systems and the associated analytic tools.
General Duties- Upholds and supports the company's mission, vision, and values
- Perform other miscellaneous job-related duties as assigned by the Vice President of Health Plan Contracting.
RequirementsEducationExperience- Five or more years experience in healthcare financial operations.
- Health plan contracting experience preferred.
- Experience working with hospital Electronic Health Records (EHR) and billing systems (e.g., Epic, Cerner, Meditech).
Skills and Knowledge- Ability to define and prioritize specific realistic, goals and objectives
- Ability to identify, analyze and effectively resolve operational and administrative problems
- Ability to work independently and manage multiple projects simultaneously
- Ability to be trustworthy
- Ability to professionally and successfully interact with a variety of internal and external parties
- Communicates openly and in a timely way
- Shares information appropriately
- Keeps others well informed
- Responds in a timely manner to messages/requests
- Knowledge of hospital revenue cycle and the impact of such operations on hospital reimbursement
- Knowledge of hospital and physician health plan contracts, and the impact of such contracts on hospital operations
- Knowledge of all types of healthcare payer sources such as commercial, governmental, workers compensation and others
- Proficient understanding and application of the concepts and terminology unique to the healthcare industry
- Medicare and Direct Data Entry (DDE) experience preferred, not required
- Understanding of electronic files; 837, 835, 277
- Understanding of the complete revenue cycle process and the financial implications.
- Understanding of Protected Health Information (PHI), along with HIPAA \ HITECH rules and regulations.
- Intermediate level user of Excel and/or Google Sheets
- SQL Report Writing Skills preferred
BenefitsAt CHC we enjoy an outstanding work environment, covered parking, comprehensive health and welfare benefits including paid fitness facility membership, tuition reimbursement, a generous PTO allowance, and a great company culture. Comprehensive health and welfare benefits package is offered as part of total compensation:
- Health Care Plan (Medical, Dental & Vision)
- Retirement Plan (401k, IRA)
- Life Insurance (Basic, Voluntary & AD&D)
- Paid Time Off (Vacation, Sick & Public Holidays)
- Wellness Resources and other benefits
