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White Plains Hospital · 3 months ago

Managed Care Analyst

White Plains, NY

Full-time

Onsite

Entry, Mid Level

2+ years exp

White Plains Hospital is seeking a Managed Care Analyst to assist in analytics, reporting, and validation of reimbursement from third-party plans. The role involves preparing reports, maintaining relationships with payer representatives, and ensuring adherence to contract terms.

Health CareHealth DiagnosticsMedical

Comp. & Benefits

Responsibilities

Understands and adheres to the WPH Performance Standards, Policies and behaviors

Provides support for special projects which include collecting, analyzing, and modeling claim data in preparation for payer contract negotiations at least four months in advance of contract renewal

Analyzes reimbursement utilizing appropriate rates based on contract structure

Responsible for assisting in testing and maintenance of contracts, including fee schedules in host system and contract software tools

Assists with testing of contracts to confirm methodology, including matching current contract terms and rates

Assists in preparation of contract reference guide along with summary of terms for loading and distribution to revenue cycle team

Performs audits and reconciliation of plan payments to contract terms, identifying any variance and communicating to leadership and managed care team issues identified

Responsible for working with third party payers to rectify contract discrepancies identified because of payment audits

Responsible for preparation and maintenance of provider representative escalation files

Takes meeting minutes and provide updates to leadership on provider representative JOC calls

Assists with the preparation of data and terms for contract modeling

Assists with quality measurement of contract modeling application for accuracy

Maintains current knowledge of state and federal regulations, monitors payer policy changes and requirements, and communicates changes to HQ Staff as appropriate

Conducts revenue cycle analysis, trending, prepare month-end reports and make continual assessments of plan contract performance and progress

Responsible to provide analysis, reporting and recommendations for plan specific contracts and future negotiations to Senior Management and Managed Care Team

Assists with audits of plan payments and denials to assure plans are adhering to contract terms and rates, along with escalation of any findings not in line with our contract terms

Maintains knowledge of all aspects of third-party reimbursement policies and practices

Tracks, trends, and reports out on all initiatives and projects to senior leadership

Responsible for compliance with hospital and Human Resources policies and procedures, competency and education requirements are satisfied as per hospital policy

Participates in the Performance Improvement Program as defined by the organization

Is responsible to participate in committees, task forces and projects as appropriate

Ensures the provision of a safe employee/patient environment

Works collaboratively with all levels of the hospital interdisciplinary team and promotes the team concept within their department and hospital wide

Demonstrates positive customer service, fosters positive employee relations and assures that staff adheres to the Customer Service Behavioral Standards

Is supportive of hospital initiatives and projects and functions as a positive change agent

Performs all other related duties as assigned

Qualification

Healthcare reimbursementContract modelingAnalytical skillsMicrosoft ExcelPatient accountingTroubleshooting skillsCommunication skillsTeam collaborationIntegrity

Required

Graduate of an Accredited College or University with a B.S. in Business or Health Administration required

Minimum of (2) to (4) years in Patient Accounting required, preferable in a hospital setting

3 years of demonstrated strong analytical skills with knowledge of patient accounting, third party contracting, and/or contract modeling systems or healthcare reimbursement

Proficiency with Microsoft office/excel to include reporting, Executive level required

Proficient in excel and preparation of reports and presentations

Strong analytical and troubleshooting skills

Knowledge of hospital billing and reimbursement of insurance as well as third-party billing

Ability to understand payment methodology and utilize formulas

In-depth knowledge of the complete healthcare revenue cycle

Experience/knowledge of contract language and payment methodology

Strong communication skill sets and abilities

Ensures compliance with state regulations and accreditation standards

Utilizes multiple methodologies to communicate information

Maintains an in-depth knowledge of revenue cycle principles, practices, procedures, regulatory compliance and internal controls

Integrity to handle the confidential aspects of work