Director, Managed Care Quality Analytics - Remote

Job Purpose

The Director, Managed Care Quality Analytics plays a critical role in advancing the evolution of analytics, validation, and quality assurance (QA) processes within the organization. This position is responsible for analyzing and ensuring the accuracy of contract pricing for both physician and hospital-based reimbursement. The initial focus of this role will be to develop, define and execute heatmap QA processes for all End-to-End clients. The Director, Managed Care Quality Analytics will prepare detailed reports on contractual variances, identify discrepancies, and collaborate with the Managed Care Contracting team and Contract Management Application Development team, to resolve issues with contract load or calculation mechanics, ensuring alignment with agreed-upon contract terms. This role directly contributes to improving pricing accuracy and supporting the overall success of the Managed Care and Contract Management Application Development Teams.

Duties & Responsibilities

• Own the analytical processes for the implementation and ongoing assessment of the company’s insurance pricing, ensuring accuracy in expected reimbursements and identifying areas for optimization
• Manage and perform in-depth analysis of large data sets using advanced Excel and (if possible) SQL techniques to detect and flag incorrect pricing trends and discrepancies
• Create and send cross-departmental communications, noting trends, discrepancies, and insights to key departments such as Accounts Receivable (AR) Valuation, AR Services, and other relevant teams
• Develop and implement quality assurance processes for both physician and hospital pricing models, swiftly identifying areas for improvement and operational efficiency.
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
  
  

Qualifications

• Bachelor’s degree in a related field preferred
• Extensive knowledge of the healthcare landscape, third-party data sources, market access, and managed care performance
• Minimum of 5 years of professional experience, including at least 3 years of focused experience in financial analysis and managed care required
• Ability to effectively interpret managed care contracts and reimbursement structures
• Solid understanding of government reimbursement models, ensuring accuracy in pricing and reimbursement projections.
• Proficiency in Microsoft Office Suite required, with advanced knowledge of in Excel, (MS SQL is desirable but not required), with the ability to manage, analyze, and interpret large data sets to derive actionable insights
• Ability to thrive and maintain a high level of performance in a fast-paced, dynamic work environment
• Strong interpersonal skills, ability to with the ability to present complex data and insights clearly to stakeholders across various departments
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction
  
  

Working Conditions

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.
  
  

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.