What are the responsibilities and job description for the Senior Managed Care Analyst (Remote/Hybrid) - Oceanport, NJ position at RWJBarnabas Health?
Senior Managed Care Analyst (Remote / Hybrid) - Oceanport, NJReq # : 0000150834
Category : Professional / Management
Status : Full-Time
Shift : Day
Facility : RWJBarnabas Health Corporate Services
Department : Managed Care
Location :
SBC Corporation, Oceanport, Oceanport, NJ 07052
Job Overview :
The Senior Managed Care 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 required. Preferably in Finance, Accounting, or Healthcare related field.
Advanced knowledge of Microsoft Excel, including formulas, vlookups and pivot tables.
Experience with EPIC is strongly preferred with a Resolute Hospital Billing Certification or willing to obtain Certification within six months of employment.
Experience working with complex and sophisticated managed care contracts.
Strong analytical skills with ability to manipulate large data sets into meaningful information.
Must possess strong interpersonal and email communication skills.
Preferred :
Five years of experience relating to healthcare reimbursement, strongly preferred.
Experience solving difficult problems relating to reimbursement, contract modeling and revenue cycle functions, strongly preferred.
Licenses Required :
- Resolute Hospital Billing Certification or willing to obtain Certification within six months of employment.
Scheduling Requirements :
Essential Functions
Analytical lead on modeling contract rates using EPIC 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.
Assists in CMS-mandated price transparency efforst to ensure compliance to regulations and policies.
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.
Additional Information :
At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to support our employees physical, emotional, social, and financial health.
Paid Time Off (PTO)
Medical and Prescription Drug Insurance
Dental and Vision Insurance
Retirement Plans
Short & Long Term Disability
Life & Accidental Death Insurance
Tuition Reimbursement
Health Care / Dependent Care Flexible Spending Accounts
Wellness Programs
Voluntary Benefits (e.g., Pet Insurance)
Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!
Choosing RWJBarnabas Health!
RWJBarnabas Health is the premier health care destination providing patient-centered,
high-quality academic medicine in a compassionate and equitable manner, while delivering
a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.
RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.
Equal Opportunity Employer
RWJBarnabas Health is an Equal Opportunity Employer
