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Michigan Medicine · 1 day ago

Managed Care Payer/Operations Analyst

Michigan, United States

Full-time

Hybrid

Mid Level

4+ years exp

Michigan Medicine is a leading healthcare provider dedicated to improving health through excellence in education, patient care, community service, research, and technology development. The Managed Care Payer Analyst will support the operations of managed care agreements, assist in meetings with payers, and ensure effective communication and problem resolution within the department.

EducationHealth CareMedical

Responsibilities

Analyze and improve operational processes related to managed care for all three sites including Michigan Medicine, Sparrow Health System, and UMHWest

Collect, analyze, and interpret data related to managed care programs, including reimbursement rates, claims data, and provider performance metrics

Collect and maintain information related to payers and plan relations, including the Payer and Plan Grid, Payer Profiles and Report Cards

Oversee the tracking, follow-up, and resolution of action items resulting from various payer meetings, including Joint Operating Committee (JOC) meetings, ensuring timely execution and alignment with organizational objectives

Provide strategic support to the Managed Care Contracting and Operations team by coordinating and contributing to internal initiatives, including the Revenue Cycle Forum, with a focus on integration and alignment across all three health systems

Partner with the Manager of Managed Care Operations and the Senior Director of Managed Care Contracting and Operations to plan, coordinate, and support Joint Operating Committee (JOC) meetings with payers across Michigan Medicine, UMH-Sparrow, and UMH-West, ensuring alignment with organizational priorities and contractual obligations

Engage in Payer Oversight Committee meetings to evaluate and address escalated payer issues submitted through the SBAR process, serving as a strategic review point for determining the appropriateness of advancing concerns to Joint Operating Committees (JOCs)Responsible for creation, dissemination, maintenance and tracking action items toward resolution of various payer meeting minutes, including but not limited to Joint Operating Committee meetings (JOCs)

Create, distribute, maintain and track various payer meeting agendas, including but not limited to Joint Operating Committee meetings (JOCs)

Responsible for tracking and following up on action items from various payer meetings, including but not limited to Joint Operating Committee meetings (JOCs), and reporting progress status

Assist and represent the Managed Care Contracting and Operations team with internal meetings, such as the Revenue Cycle Forum as it pertains to all three health systems

Liaison to all areas within Michigan Medicine relating to payer activity including key departments that directly interact with payers including Revenue Cycle, Care Management, Pharmacy, and the professional medical groups

Collaborate with the Manager, Managed Care Operations to ensure accurate and timely dissemination of payer-related information

Responsible for reviewing and responding to issues/concerns submitted from both internal and external constituents to the department shared email inbox in a timely manner

Create, coordinate, edit, and assist with PowerPoint presentations, Word documents, and Excel spreadsheets, as needed

Collaborate with the Manager, Managed Care Operations, to create and distribute periodic update reports for all functional/operational areas

Work in collaboration with team members within the MCCO Department

Other duties as needed and/or assigned

Qualification

Healthcare industry experienceManaged care operationsData analysisMicrosoft Office SuiteProject managementCommunicationInterpersonal skillsDetail-orientedTeam collaboration

Required

Bachelor's degree in healthcare administration, business, or related field is preferred. Equivalent work experience is acceptable

Minimum of four (4) years of experience working in the healthcare industry or managed care organizations

Excellent written and verbal communication skills, with the ability to convey complex information clearly and effectively

Strong interpersonal skills and ability to build and maintain relationships with diverse stakeholders both internal and external

Proficiency in Microsoft Office Suite, including but not limited to Microsoft Excel, PowerPoint, and Word

Detail-oriented with strong organizational, time management, and decision-making skills

Ability to work both independently and as part of a team environment in a hybrid environment

Ability to manage multi-faceted tasks in a fast-paced work environment while maintaining the level of detail critical to managed care operations

Preferred

Prefer to have experience with EPIC Electronical Medical Records System

Project management experience

Company

Michigan Medicine

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Michigan Medicine is a health care system and academic medical center that provides medical education and more. It is a sub-organization of University of Maichigan.

Founded in 1869

Ann Arbor, Michigan, USA

10001+ employees