Senior Managed Care Analyst - Visalia, United States - Kaweah Health Care District

Kaweah Health Care District Visalia, United States

3 weeks ago

Description

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California.

With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics.

Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care.

It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing.

Throughout it all, our focus is to make a difference, and we do - in the health of our patients, our loved ones, and our community.

Benefits Eligible

Full-Time Benefit Eligible

Work Shift

Day (United States of America)

Department

8513 Finance-Managed Care Svcs

Provides technical and consulting support regarding all Managed Care contracts within Kaweah Health.

Ensures effective audit/review of all data sources in preparation of reporting of all managed care contracts, including the maintenance of adequate internal systems and controls.

Supports management decisions by providing financial analyses and forecasts of operations through timely reporting and data analysis.

Responsible for managed care contract review and analysis, capitation contract reporting and contract fulfillment analysis within the Managed care department.

Assists management in contract implementation with various departments. Supports operations and contract interpretation to departments within the Kaweah Health. Analytically reviews departmental output and the associated applications. Completes special projects as assigned.

QUALIFICATIONS
Education

Required:
MBA or Bachelor's degree

Preferred:
Bachelor's degree with an emphasis in business, finance, accounting or health care administration.

Experience

Required:
Minimum of two years of healthcare/healthcare auditing, patient accounting, managed care contracting or medical group practice field. Minimum of ten years' experience in healthcare or related field (only required if candidate does not have an MBA).

Preferred:
Managed Care experience

Knowledge/Skills/Abilities

Possesses excellent analytical, mathematical, deductive reasoning and problem solving skills and the ability to work collaboratively and communicate effectively with all levels of management and staff.

Proficiently organizes, analyzes and presents financial information.

Operates in a productive, self-motivated and forward-thinking manner.

Possesses proficiency with computer technology and in developing and maintaining effective microcomputer spreadsheet applications.

JOB RESPONSIBILITIES
Essential

Supports management with decisions by providing financial analysis and forecasts of claims paid data, provides managed care expertise and support to produce meaningful, timely, accurate and understandable information which enhances the decision-making process.

Analyzes monthly claims paid data results, researches significant variances within a timely manner and reports results to management.

Develops and maintains expertise sufficient to complete reports in a reviewable manner. Effectively operate supporting computer software programs.

Processes information for and is proficient in developing and maintaining microcomputer applications.

This includes, but is not limited to Microsoft Access database and query building to ensure timely and accurate ad hoc data analysis.

Provides accurate managed care contract interpretations and acts as a liaison between Kaweah Health and health plans.

Supports the Managed Care Manager/Director in contract analysis, reporting and provider relations.

Effectively utilizes the computer to eliminate manual record keeping and promote greater efficiency.

Recognizes the importance of all reports and information generated for both internal/external processes and the reliance placed thereon for decision-making purposes.

All reports, dashboards and information generated are accurate, complete and timely. These are subject to self-review and analysis prior to distribution or submission.

Administers financial systems. In conjunction with management, designs, implements and maintains the structure and parameters related to these systems. By completing monthly analysis, ensures accurate and timely data is entered into these systems. Prepares/runs monthly reports from these systems and distributes to management or other responsible managers/directors/executives.

Completes special projects as assigned and analytically reviews departmental output and the associated applications. Completes special projects accurately, thoroughly, timely and in a manner which allows for effective review.

Possesses necessary skills to develop and challenge rational assumptions and forecast methodologies.

Addendum (essential for specific dept)

IF ASSIGNED TO KAWEAH RESPONSIBILITIES:

Provides interpretation and expertise on all managed care contracts and capitation arrangements, assisting with education on all terms of the contracts..

Assists leadership with network building for capitation agreements. Assists finance in reporting for reconciliation of the financials.

Ensures maximum reimbursement and accuracy of all billed claims for capitated services and reconciles both systems to capture all data elements.

Assists Manager with managed care contract analysis by utilizing database, developing queries and building usable and accurate reports for health plan contracts.

Assists patient accounting with payor issues by acting as a liaison between the Kaweah Health and all health plans.

Assists leadership with implementing and interpreting managed care contracts to Kaweah Health staff, providing guidance on reimbursement and forecasting revenue to Kaweah Health leadership.

Completes all contracting responsibilities for all professional service contract for Kaweah Health and all physician contracted services. Maintains a strong working knowledge of professional reimbursement, billing and credentialing.

Directs and coordinates implementation of all Kaweah Health new services and locations as it relates to contracting, reimbursement forecasting and system creation or maintenance.

Additional

Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.

Performs other duties as assigned.

Pay Range

$37.42 -$56.14

If you want to use your talents alongside people who face each day with courage and purpose, in an environment that empowers you to do your absolute best, this is where you belong.

staff services analyst

2 weeks ago

Department of Food & Agriculture Tulare, United States

Job Description and Duties · Per CCR 249.3, this job control may be used to fill subsequent vacancies. · The Inspection and Compliance (I&C) Branch is recruiting to fill one (1) Staff Services Analyst position located in Dinuba, CA. · Under the supervision of the Agriculture Pro ...
Travel Nurse RN

1 week ago

LanceSoft Visalia, CA, United States

LanceSoft is seeking a travel nurse RN CVICU for a travel nursing job in Visalia, California. · Job Description & Requirements · Specialty: CVICU · Discipline: RN · Start Date: 06/24/2024 · Duration: 13 weeks · 36 hours per week · Shift: 12 hours, nights · Employment Type: Travel ...
Behavior Technician

3 weeks ago

Butterfly Effects Visalia, United States

Behavior Technician · Visalia , Ca · MUST be Spanish Speaker to APPLY * · Butterfly Effects' Mission is to make a socially meaningful change in the lives of children and families by hiring passionate, caring people to serve children and families affected by autism. · We are loo ...
RN-Clinical Analyst

3 weeks ago

Kaweah Health Visalia, United States

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive service ...
Senior Staff Accountant

1 week ago

Kaweah Health Care District Visalia, United States

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive service ...
Behavior Analyst

22 hours ago

Autism Learning Partners Visalia, United States

If you are interested in a career where you can be a leader in clinical excellence, have a clear career growth plan, and learn from one of the largest networks of BCBAs, wed love the opportunity to talk to you The Basics of this opportunity: Total 1st year Earning Potential: $94, ...
Occupational Therapist

6 days ago

Pioneer Healthcare Services Visalia, United States

Pioneer Healthcare Services is seeking a committed Occupational Visalia, CA for a 13-week contract with the possibility to extend. The qualified Skilled Nursing Facility SNF Occupational Therapist OT will act as the patients' partner throughout their daily tasks and assist patien ...
Director of Health Information Management

2 days ago

Kaweah Delta Visalia, United States

Director of Health Information Management page is loaded · Director of Health Information Management · Apply · locations · Visalia, California · time type · Full time · posted on · Posted 6 Days Ago · job requisition id · R24_ · Kaweah Health is a publicly owned, commu ...
Population Health Data Analyst

1 week ago

Kaweah Health Visalia, United States

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive service ...
ABA Technician

2 weeks ago

Maxim Healthcare Service Visalia, United States

Pay: Hourly pay varies between $20 - $24 depending on experience or related education/certification. · Maxim Healthcare Services (Fresno) is hiring for a Behavioral Technician to work one-on-one with children with Autism. · Why Join Maxim: · * Competitive Pay & Weekly Paychecks · ...
Eligibility Worker I

3 weeks ago

Health Advocates Visalia, United States

Job Description · Job DescriptionHealth Advocates is seeking Eligibility Workers for our hospital site in Visalia, CA. · WE OFFER PAID TRAINING · Job Summary · Eligibility Workers help qualify patients/claimants for governmental benefits (Medi-Cal, VOC, SSI/SSDI, TPL, etc.) withi ...
Business System Analyst

3 weeks ago

Creative Financial Staffing Tulare, United States

Business System Analyst · Must be local to Tulare area | No sponsorship offered · About the company · Our client is a leading manufacturing company their service industry. They are needing to add a Business System Analyst to their team. They are known for their excellent healt ...
REGISTERED BEHAVIOR TECHNICIAN

4 weeks ago

California Department of Education Tulare, CA, United States

Requirements / Qualifications · PROOF OF THE FOLLOWING REQUIREMENTS MUST BE SUBMITTED WITH THIS APPLICATION TO BE CONSIDERED FOR THIS POSITION. 1. High School Diploma or equivalent 2. Current Registered Behavior Technician Certification issued by the Board Analyst Certification B ...
REGISTERED BEHAVIOR TECHNICIAN

4 weeks ago

Tulare City School District Tulare, CA, United States

About the Employer · Tulare City School District happily serves over 10,000 preschool through eighth-grade students enrolled at fifteen individual school sites. Our Board of Trustees, administration and staff are committed to the district's common expectation to "raise up caring, ...
Child Interventionist

5 days ago

Butterfly Effects Tulare, United States

CHILD INTERVENTIONIST · TULARE , CA · Seeking Bilingual Spanish speakers Only · Do you love spending time with children and want to make a lasting impact in the lives of children and families? We have a uniquely rewarding part-time job opportunity waiting for you · Butterfly Effe ...
staff services analyst

1 week ago

California Correctional Health Care Services Kings County, United States

Job Description and Duties · Under the supervision of the Supervising Registered Nurse II (SRN II) Whole Person Care Program, the Staff Services Analyst (SSA) is responsible for providing administrative and technical support for the analytical duties involved in the planning, de ...
Behavioral Interventionist

5 days ago

Maxim Healthcare Kingsburg, United States

Pay: Hourly pay varies between $20 - $23 based off experience or related education/certification. · Maxim Healthcare Services (Fresno) is hiring for a Behavioral Technician to work one-on-one with children with Autism. · Why Join Maxim: · * Competitive Pay & Weekly Paychecks · * ...
ABA Behavioral Therapist

5 days ago

Maxim Healthcare Porterville, United States

$20 - $24 · Salary: Pay varies based on experience and education. · Maxim Healthcare Services (Fresno) is hiring for a Behavioral Technician to work one-on-one with children with Autism and Behavioral Disorders. · Why Join Maxim? · * Competitive pay & weekly paychecks · * Flexibl ...
Registered Behavior Technician

5 days ago

Maxim Healthcare Services lemoore, United States

$24 · Maxim Healthcare Services (Fresno) is hiring for a Behavioral Technician to work one-on-one with children with Autism and Behavioral Disorders. · Why Join Maxim? · + Competitive pay & weekly paychecks · + Flexible scheduling - PT and FT · + College Partnership programs ...
Travel Physical Therapist

2 weeks ago

LanceSoft Kingsburg, CA, United States

LanceSoft is seeking a travel Physical Therapist for a travel job in Kingsburg, California. · Job Description & Requirements · Specialty: Physical Therapist · Discipline: Therapy · Start Date: 06/16/2024 · Duration: 13 weeks · 40 hours per week · Shift: 8 hours, days · Employment ...