MANAGED CARE FIN ANLST

Overview

Managed Care Financial Analyst, Managed Care

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times. 

Position Summary: 

In conjunction with others in the Managed Care Department, this position is responsible for assisting in the coordination of the contract management process for managed care contracts for all Covenant Health providers including hospitals, physicians, surgery centers, diagnostic centers, behavioral professionals, and home care.  The position will oversee the contracting, contract building/rate modeling/payment performance process per established guidelines for these providers.  This includes, but is not limited to, assisting in the development of strategic plans, assisting with contract and rate negotiations, frequent communications with operations and business office leaders, ensuring contract compliance, assisting to resolve payment or other payer problems, internal dissemination of contract rates, terms, etc.  Finally, this position is responsible for developing and maintaining online managed care web-based tools and sites for provider contracts. This position reports to the Manager of Managed Care.

Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-374-5386

Responsibilities

• Assists in the development and revision of managed care strategic plan(s).
• Establishes and maintains good working relationships with operation and business office leaders, senior management, payers, etc.
• Following strategic priorities, helps coordinate the contracting process for third-party payer contracts per established contracting guidelines.
• Ensures ancillary rate improvement and reimbursement compliance interests are represented in System-wide contracts.
• Develops and/or maintains online managed care web-based tools and sites, and Sharepoint (fee schedules).
• Ensures payers and providers comply with all contract terms, such as annual rate updates, term notices, etc.
• Develops and disseminates reports/updates and conducts or participates in education and training sessions with key internal customers.
• Maintains regular contact with operations leaders and third-party payers to assure system developments and new services are communicated and future market changes are anticipated, including value-based contracting.
• Assists in the resolution of payment or other problems/issues with payers.
• Coordinates and/or assists in scheduling and participates in business office or other needed meetings with third party payers and providers.
• Oversees and is involved (as needed) with payer audits of ancillary and joint venture facilities. Ensures audits are performed per audit policy/procedure and contract terms. Ensures any trends, issues, concerns or recommendations for improvement ‘discovered’ during audits are shared and communicated as appropriate.
• Maintains current knowledge of changes affecting government contracts and reimbursement trends/calculations, including Medicare, TennCare, Medicare Risk, etc.
• Maintains Tennessee Healthcare Innovation Initiative Episodes of Care amendments, reporting and tracking.
• Maintains professional growth and development through seminars, workshops and professional affiliations to keep current with latest trends in the field.
• Upon successful completion of training, will be expected to develop financial projections/models reflecting changes in contracted rates and Medicare reimbursement for providers. Maintains yearly payer fee schedules. Assists with Implementing and maintaining the contract management module of the Decision Support System (DSS) with Provider information and ensures that all necessary data is audited during implementation and periodically thereafter.
• Performs modeling on all requested potential new provider contracts, and provides various reports (contract profitability, etc.) from DSS, as needed or requested, and is prepared to present this information to senior leadership. This includes attending meetings with third-party payers, as requested.
• Analyzes and evaluates results of finalized payer contracts after periods of time specified to ensure accuracy of Expected Reimbursement calculation within the Contract Analytics module, as well as appropriate payment by payers.
• Maintains and audits all payer and contract mappings from Star into the DSS.
• Meets regularly with Managed Care and Financial Analytics Teams regarding the contract management module of the Decision Support System (DSS) for training, auditing, and project assignment.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education:

Bachelor’s degree in Business or other relevant field required.

Minimum Experience:

At least three to four (3-4) years of related experience.

Licensure Requirement:

None