What are the responsibilities and job description for the Managed Care Contract Senior Biller position at The CORE Institute?
Benefits:
- Competitive Health & Welfare Benefits
- HSA with qualifying HDHP plans with company match
- 401k plan after 6 months of service with company match (Part-time employees included)
- Employee Assistance Program that is available 24/7 to provide support
- Employee Appreciation Days
- Employee Wellness Events
ESSENTIAL FUNCTIONS
- Prepare analysis related to the financial and operational performance of health care contracts, including the impact of regulatory rate or other changes and identify the financial and/or operational performance of those agreements. Recommends areas of improvement.
- Provides analysis for Medicaid and other Managed Care products such as HMO, PPOs and POS products.
- Create and maintain reimbursement schedules in third party analytic software.
- Monitor and trend third party reimbursement including denial analysis.
- Create financial models as required to analyze data and report efficiently for existing and new reports.
- Supports Management by providing information, locating data sources and collecting data under tight time constraints.
- Identify and analyze utilization patterns driving health care costs and recommend actions to impact financial performance
- Reviews all shared risk claims, capitation, risk pool settlements, and various reports submitted by the health plans. Submit shared risk discrepancy reports within the time limits required by each individual health plan and in the format requested by each individual health plan. When necessary, serves as the liaison between health plans and revenue cycle.
- Create various reports in regard to payor reimbursement for Senior Leadership.
- Charged with providing recommendations to Revenue Cycle regarding changes in utilization of those applications.
- Responsible for assisting in the development of training materials and ensures the staff of Revenue Cycle receives proper training and are knowledgeable in use of the applications.
- Extracts and queries data from multiple sources and systems and compile data in the form of written and verbal reports and presentation.
- Create queries to pull financial/claims data that will then be used to develop analytical and statistical models to help customers make informed business decisions.
- Identifies and communicates trends and/or potential issues to management team.
EDUCATION
- High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
- Must have a minimum of three years’ experience working in analytic or analyst role in a healthcare environment with an in-depth knowledge of physician reimbursement. Experience in using relational databases, decision support systems, analysis and modeling.
REQUIREMENTS
- Excellent written and verbal communication and presentation skills.
- Excellent critical thinking, troubleshooting, and analytical skills.
- Excellent interpersonal skills.
- Experience working in Excel (advanced formulas, pivot table)
- Well organized and able to meet deadlines.
- Excellent attention to detail.
SKILLS
- Skill in effective data collection and analysis.
- Interpersonal skills are essential to communicate effectively, written, and oral, with internal and external personnel at
various levels. - Skill in effectively managing multiple projects simultaneously.
ABILITIES
- Ability to multi-task and work well under pressure.
- Ability to analyze problems and interpret information and prioritize and reprioritize, as necessary.
- Ability to work independently, and as part of a team.
- Ability to read and interpret payer contracts and reimbursement rates.
