Managed Care Contract Analyst
3 weeks ago
About Us
FMOLHS is one of the largest health systems in Louisiana, with hospitals, clinics and physicians located throughout Louisiana and in Mississippi. In fact, we provide care to almost half of Louisiana’s citizens, and serve in Mississippi's largest metropolitan area. Because of our size and the partnerships we have with other local organizations, we are able to pool our resources and share cost and service efficiencies and learn from each other, thereby accelerating our ability to improve care and solve challenges.
At FMOLHS, we offer you so much more than just a job in the healthcare industry. We offer career opportunities for people who have a calling to share their gifts and talents as part of our healing ministry. As a Catholic system, we are here to create a spirit of healing. We offer you something special - the chance to do Gods work by helping to serve people in need throughout our community, every day.
Job Summary
The Managed Care Contract Analyst is responsible for analytic strategies focused on Managed Care payor contract performance. The Payor Relations Analyst drives analytics and decision support by translating actual payor contract rates, terms, volume, utilization trends, and network development challenges into actionable insights to assist in the strategic positioning of revenue, payor contracts, and overall network strategy. The Payor Relations Analyst engages clients (health plans, leaders, and providers) in reviewing reimbursement data including but not limited to financial performance, contract compliance, variance analysis, and prospective modeling of proposed contract terms. The Payor Relations Analyst will provide analyses and strategic recommendations to maximize and optimize payor reimbursement in the aggregate as well as at key service line or other detailed levels.
Job Requirements
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.
Job Function
- 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
- Evaluates, understands, and analyzes contractual language as it relates to complex contract terms and payment methodologies that impact both hospital, professional, and ancillary reimbursement
- Applies detailed understanding of medical coding systems affecting the adjudication of claims to include current ICD, CPT, HCPCS, DRG and revenue code classifications
- 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
- 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. Applies technical expertise in the development of models and decision support information
- Assists with training and mentoring of other analytic staff
- 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. Works with other team members to enhance contract modeling and reporting within the various Business Intelligence tools
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