Job Abstract

Job Overview:

The Senior Analyst assists with aspects of the fee-for-service environment related to contract negotiations, rate modeling and contract performance review. Additionally, the position will collaborate with all departments of the revenue chain to ensure revenue optimization for the health system.

Qualifications:

Required:

• Bachelor’s degree in finance or accounting required.
• Experience working with complex and sophisticated managed care contracts.
• Strong analytical skills with ability to manipulate large data sets into meaningful information.
• Advanced knowledge of Microsoft Excel, including formulas, lookups and pivot tables.
• Must possess strong interpersonal and email communication skills.

Preferred:

• 5 years of experience relating to healthcare reimbursement, strongly preferred.
• Experience solving difficult problems relating to reimbursement, contract modeling and revenue cycle functions, strongly preferred.

Scheduling Requirements:

• This role is fully remote with the option to work in-person if desired with a designated office space.

Essential Functions

• Analytical lead on modeling contract rates throughout the managed care contract negotiation process.
• Assists in varying aspects of managed care payor negotiations including proposals, rate validation, rebalancing, language review and communication with insurance companies.
• Evaluate payor performance relating to profitability, benchmarking, denials, contract compliance and retrospective reviews.
• Collaborates with the system business office to provide support relating to contract interpretation, denial reviews, payment variances, and cost-based audit reviews.
• Supports the loading of payor contracts into the contract management system and validates accuracy at time of implementation.
• Collaborates with hospitals on creation and/or review of revenue proformas relating to new service offerings.
• Leads managed care payor projects in determining financial impact and progress tracking.
• Works with outside vendors on projects relating to revenue recovery and strategic pricing assessments.
• Research changes relating to managed care payor policies and determine financial impact to the health system.
• Models financial impact of new technologies, and provides timely notification to payers in accordance with contractual terms.
• Serves as a managed care resource across the organization assisting with reimbursement inquires, contractual rate grids, facility credentialing and various ad hoc requests.
• Special projects as assigned.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.