Managed Care Contract Analyst 3 - Baton Rouge, United States - Franciscan Missionaries of Our Lady Health System

Description

Responsibilities

Job Standards and Performance Expectations

• 1. Supports and collaborates with managed care leadership and team members in contract negotiations through detailed financial modeling, comparative analyses, and
  benchmarking of changes in fee for service and value-based contract rates and terms
  
  2. Evaluates, understands, and analyzes contractual language as it relates to complex contract terms and payment methodologies that impact both hospital, professional,
  and ancillary reimbursement
  
  3. Applies detailed understanding of medical coding systems affecting the adjudication of claims to include current ICD, CPT, HCPCS, DRG and revenue code classifications
  
  4. Develops and performs analytical and planning functions in support of Managed Care decision making during payor negotiations and ways to help the organization achieve its annual operating goals
  
  5. Completes timely and accurate financial analyses related to Managed Care net revenue impact and variance explanations and presents findings in a succinct manner
  to appropriate stakeholders
  
  6. Applies technical expertise in the development of models and decision support information
• 7. Assists with training and mentoring of other analytic staff
• 8. Design, develop, and deliver ad hoc reporting and analysis by key indicators such as facility, payor, patient type, volume, service line, and other detailed grouping as
  needed to identify areas in which to optimize revenue performance of both existing and proposed contracts
  
  9. Works with other team members to enhance contract modeling and reporting within the various Business Intelligence tools
  
  10. Performs other job-related duties as assigned to fulfill departmental responsibilities

Qualifications

Minimum Required:

Experience: Five years of analytic experience with emphasis in healthcare and/or clinical application and health insurance finances

Education: Bachelor's degree in Business, Finance, Economics, Mathematics, Accounting, Statistics, or related field

Special Skills: Technical experience in applying business mathematical skills, utilizing analytical software tools and applications for contract negotiations, contract financial modeling, contract language interpretation, and problem-solving. Proficiency using the Microsoft Office Suite, data warehouse applications, and EPIC (preferred). Experience working with healthcare, insurance, or claims data.

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