At Franciscan, our Senior Managed Care Reimbursement Analysts work with the Facility Information Systems and Health Information Management to extract the data necessary to perform ongoing analysis of all account-based, reimbursement transactions for accuracy. The position analyzes Facility Managed Care contracts, reconciles to payments received, and makes recommendations to prevent future cash losses.

• Support the System’s reimbursement strategies and initiatives through analysis of performance objectives and assessment of changes necessary for migration from a fee-for-service reimbursement to a risk-based reimbursement/capitation environment.

• Management of reports to monitor variances between managed care contracts, compare expected reimbursement rates by site and service, and benchmark to other payment rates (e.g. Medicare).

• Develop financial and planning models to evaluate the impact of proposed reimbursement initiatives, contracts, amendments, payment disputes, and changes in regulation or provider manuals.

• Perform reimbursement modeling for new strategic projects or services and with managed care contract scenario modeling.

• Conduct the strategic reimbursement modeling to support changes to the charge master.

• Access rate schedules, product details, and historical claims to build and deploy model scenarios. Leverage multiple data points to provide visibility into all key model components.

• Synthesize data, opportunities, issues/challenges, and articulate findings, conclusions, and recommendations.

QUALIFICATIONS

• Bachelor's Degree Business, Statistics, Information Systems, Healthcare Management or related - Required

• Master's Degree Business, Statistics, Information Systems, Healthcare Management or related - Preferred

• 7 years Reimbursement/Analyst - Required -AND-

• 5 years Healthcare Managed Care Modeling - Required

• EPIC Certified or Accredited - EPIC obtained within 180 days - Required