What are the responsibilities and job description for the Managed Care Analyst position at North Mississippi Health Services?
Posting Description At North Mississippi Health Services, our mission is to “continuously improve the health of the people of our region.” We aim to “provide the best patient and family-centered care and health services in America.” We believe that fulfilling our mission and vision calls us to embrace the best people who form incredible connections with our patients and families. We take pride in celebrating everything that makes you unique—your talents, perspectives, and passions. At North Mississippi Health Services, we believe in connecting your passion with a purpose. You know what connected feels like when you are part of our team. #WhatConnectsYou Job Description JOB SUMMARY The Managed Care Analyst at North Mississippi Health Services is responsible for analysis of all current and future payor contract terms for NMHS locations, including gathering, storing, and maintaining performance data to support all payor negotiations. This role operates under the guidance of the Director of Managed Care and utilizes strong area knowledge alongside excellent critical thinking, organizational, and communication skills to maintain and utilize up-to-date data and information, and interface effectively with a variety of internal and external stakeholders to pursue and achieve optimal contract terms. JOB FUNCTIONS Customer Service: Act as a liaison with additional NMHS corporations, including joint venture partners, to request, track and add payor updates to produce rate-trend forecasting/budgeting/reporting models and partner with finance, accounting, central business office and operational teams to distribute and educate on the related data and findings/information. Reporting: Use contract terms and performance data to model scenario-based impacts by payor product to help support and inform contracting strategy and negotiations. Regulatory: Conduct research on new government healthcare reimbursement and regulations changes (including commercial payor policy changes) and lead communication and coordination with operational teams and the central business office for both required and opportunity implementation. General: Provide additional support to prepare and coordinate managed care meetings with payors and health system partners to provide consistent, accurate data and presentations. Remain thoroughly knowledgeable regarding Managed Care programs and policies. Perform other related duties requested by Director while demonstrating a willingness, ability and team spirit to provide optimal customer service. QUALIFICATIONS Education Education Level Education Details Required/Preferred Bachelor's Degree in Finance, Accounting, Business Administration or related field Required And Master's Degree (MHA, MPH, MBA) Preferred Licenses and Certifications Licenses and Certifications Licenses and Certifications Details Time Frame Required/ Preferred Work Experience Number of Years Work Experience Details Required/ Preferred Previous professional experience in healthcare finance related field Preferred And Prior experience in contract modeling, healthcare billing, medical record coding, provider reimbursement or related field Preferred And Previous experience with payor contract modeling Preferred And Prior experience of reimbursement methodologies and concepts and common reimbursement methodologies (DRGs, per diems, fee schedules, APCs, etc.). Preferred And Strong payer operational experience within a health system Preferred Knowledge Skills and Abilities Knowledge, Skills, Abilities Required/Preferred Proficiency Strong oral and written communication skills, organizational and interpersonal skills, and analytical skills, required Required N/A Strong critical thinking skills; required Required N/A Advanced Microsoft Excel and PowerPoint skills; preferred Preferred N/A Possesses working knowledge of relational databases, healthcare industry code systems (ICD, CPT, NDC, etc.), and discrete data management concepts; preferred Preferred N/A Possesses ability to work independently, while exceeding productivity deadlines Required N/A Possesses ability to think creatively, highly driven, self-starter Required N/A Exhibits exceptional attention to detail and analysis quality/accuracy Required N/A Possesses excellent analytical skills Required N/A Utilizes independent judgement while resolving identified NMHS issues pertaining to contract interpretation Required N/A Leads meetings with internal staff and payers to address documented Managed Care Issues Required N/A Recommends policies and procedures consistent with Managed Care objectives Required N/A Compiles payor data and reports appropriately Required N/A Participates on other committees as needed Required N/A Strives to foster and maintain positive payer relations Required N/A Interacts extensively with: NMHS facilities, Payers, financial managers, ancillary personnel, and other NMHS staff members Required N/A Demonstrates excellent written and verbal communication skills Required N/A Remains courteous and professional Required N/A Reflects a positive, caring attitude toward clients, patients, staff and the public we serve Required N/A SCOPE Freedom To Act: Problem Solving: Impact: Financial Responsibility: Sales Revenue Target Responsibility: Approval Responsibility: P & L Responsibility: Assets Controlled: Controllable Expenses (e.g., Payroll and other budgeted items): Total Financial Responsibility: Budget Responsibility Primary Budget Responsibility: Shared Budget Responsibility:
