MANAGED CARE ANALYST-HYBRID

Job Overview : Performs analysis and rate modeling of managed care contracts in support of negotiations, re-negotiations and renewals. Analyzes rate proposals and develops strategies to increase revenue. Supports data driven decision making by formulating recommendations based upon data, trend analysis, financial and operational modeling and strategic market research. Performs a wide variety of duties including working collaboratively with internal stakeholders to drive key managed care initiatives and programs. Collaborates with Managed Care team, and internal stakeholders to develop rate structure proposals for payer negotiations. Interprets managed care contracts regarding contract and reimbursement terms, conditions, policies, guidelines and regulations, and keeps them current and accurate in various systems as assigned. Loads and ensures that managed care contracts rates and fee schedules are entered accurately in internal systems, including Epic. Updates contract management system in a timely manner with fee schedules and updated payment rates to ensure contracts rate remain current. Quality checks all contract builds in modeling system to validate contract build accuracy aligns with contractual agreement. Coordinates with revenue cycle and other financial staff to develop data sets for modeling. Works with revenue cycle staff to incorporate annual rate changes to the charge description master (CDM) into payer contract modeling and contract management, and calculates CDM impact for required payer notifications. Reviews and interprets managed care contracts regarding contract and reimbursement terms, conditions, policies, guidelines and regulations, and keeps them current and accurate in various systems. Validates the quality and accuracy of underlying data used for analysis and financial reporting. Works under the guidance of Manager, Managed Care Analytics or designee and within broad guidelines and technical standards. Follows-up with the payer as appropriate to obtain additional reimbursement information. Leads ongoing maintenance and auditing of contract management rate calculations. Works with Managed Care team to identify trends, and to review, and research variances. Communicates effectively with Managed Care team, payer representatives, and other internal and external stakeholders. Makes recommendations on contracting rates for new agreements and or renegotiated agreements based on existing rate information. Ensures all Protected Health Information is always kept in a secure location. Completes other projects as assigned. Job Requirements : Bachelor's Degree in Finance business analytics, economics, computer science, biostatistics, health care administration, business administration, public health, finance, accounting, engineering, informatics, related field EPIC Contract Modeling (or equivalent) Equivalent experience accepted in lieu of degree Excel and Power Point proficiency, familiar with SQL and Data visualization technology 3-4 years experience Professional Healthcare Managed Care Analytics Job Responsibilities : Performs analysis and rate modeling of managed care contracts in support of negotiations, re-negotiations and renewals. Analyzes rate proposals and develops strategies to increase revenue. Communicates effectively with Managed Care team, payer representatives, and other internal and external stakeholders. Collaborates with Managed Care team, and internal stakeholders to develop rate structure proposals for payer negotiations. Interprets managed care contracts regarding contract and reimbursement terms, conditions, policies, guidelines and regulations, and keeps them current and accurate in various systems as assigned. Loads and ensures that managed care contracts rates and fee schedules are entered accurately in internal systems. Validates the quality and accuracy of underlying data used for analysis and financial reporting. Works under the guidan