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Children's Health · 1 day ago

Managed Care Contracts Sr Analyst

Dallas, TX

Full-time

Hybrid

Senior Level

5+ years exp

Children's Health is dedicated to making life better for children through exceptional health care services. The Managed Care Contracts Sr Analyst will be responsible for complex data and financial analysis related to managed care contracts, ensuring accurate contract performance and providing critical insights to leadership.

AssociationHealth CareHospitalMedical

Comp. & Benefits

Responsibilities

Collaborate with other departments to prioritize and ensure Managed Care contract performance and all related analytic needs are met for the system. Serve as a mentor to other Analysts on the team and a subject matter expert to other CHST departments

Complete financial impact analysis of all contract negotiations, including modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of these proposals for future year(s) and developing alternative proposals within the budget parameters. Present analysis and recommendations to leadership

Prepare multiple analyses and presentations by extracting data from systems including Crystal, EPIC, STRATA and other Children's Health Services of Texas (CHST) systems and relational databases utilizing expertise in Excel. Evaluates the need to create new or modify existing ad hoc and/or customized reports

Review all Managed Care contracts and amendments as received and complete require system updates, ensuring that all contracts in EPIC are current and calculating correctly

Analyze contracts and prepare all supporting schedules necessary to update/maintain the EPIC system on a current basis. This includes but not limited to: reviewing all new contracts/amendments, meeting with Revenue Cycle staff to review changes, communicating with the payors to receive all updates on current basis, researching and downloading data form payor sites, analyzing and comparing new fee schedules to the prior fee schedules, preparing all uploads, validating input and updating EPIC reimbursement contracts

Stay abreast of all Texas Medicaid & Healthcare Partnership (TMHP), CMS and other governmental regulation changes that affect Fee Schedule pricing. Proactively model all changes to fee schedules to determine the financial impact on CHST revenue and communicate with leadership

Accountable for the maintenance of the Payor and Plan database in EPIC. Facilitate monthly meetings and seek agreement before any changes are made. Maintain the synchronization among the service areas. Ensure all plans are mapped to correct contract in EPIC and facilitate audits, at least on a quarterly basis

Interprets managed care contract terms and validates understanding with the contract negotiator and model relevant parameters into contract model application for contracts with annual revenue in excess of $2.3 Billion

Accountable for contract model module and/or application, including but not limited to the maintenance of commercial and government Managed Care Organization (MCO) contracts, fee schedules and other tables relating to contract modeling generating annual CHST revenue of in excess of $1.5 Billion

Actively participates on cross functional teams to identify revenue enhancement opportunities and develop and implement solutions for under-performing facility and professional contracts, including improvements in denials and underpayments. Provides necessary reporting and analytics to support the goals of these teams

Communicates difficult and/or sensitive and confidential information. Handles confidential material on a regular basis and is responsible for protecting the confidentiality of such information within the established guidelines of CHST and law

Supports the Senior Director, Managed Care with existing and new projects/initiatives

Works in a fast-paced environment with frequently changing priorities

Qualification

Financial analysisContract modelingEPIC systemData miningHealthcare experienceExcel proficiencyEpic certificationAnalytical skillsCommunication skillsMentoring