Managed Care Analyst II, Variance Analysis
2 months ago
About Us
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.
Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
The Opportunity
Under the direct supervision of the Manager, Payer Variance, the Managed Care Analyst II supports activities focused on payer payment, various analytics, payment recoveries and notification of overpayments when detected, utilizing multiple database applications. This candidate will actively interact with colleagues, other departments within MGB, and external parties (i.e. Payers) to optimize revenue capture.
- Use the Mass General Brigham values to govern decisions, actions and behaviors.
- Independently and accurately analyze third party payment variances and determine root causes for discrepancies, utilizing database tools in a timely manner, may require research of payer policy.
- Record and monitor payment variances detected independently, communicate detected payment variances to manager.
- Resolve underpayment variances directly with payers when indicated.
- Participate in payer operations and revenue analyses meetings internally and externally as necessary.
- Compile summary variance reports, for potential/actual recoveries, for Management.
- Participate, as requested, in ad-hoc financial analyses, in collaboration with other Revenue Finance Departments.
- Provide training and assistance to new staff at Manager request.
- As directed, input/correct rates within contract modeling system; follow up on logic configuration issues with internal parties and/or vendor, as needed.
- May participate in the development of any required/customized reporting for use within Payer Variance.
- Actively participate in process improvement initiatives including, but not limited to the MGB RCO 'ESP - Everyone Solves Problems' initiative.
- Other duties as assigned.
Qualifications
- Bachelor's degree preferred.
- Healthcare finance/billing/reimbursement experience, minimum of 2 years - professional setting preferred.
- A combination of education and experience may be substituted for requirements.
Skills for Success
- Exceptional interpersonal skills to effectively communicate with cross functional teams including staff at all levels of the organization.
- Ability to successfully negotiate and collaborate with others of different skill sets, backgrounds and levels within and external to the organization.
- Strong problem solving and negotiation skills.
- Ability to effectively conduct meetings, both formal and informal.
- Requires minimal direction from leadership and possesses the ability to learn quickly.
- Proficient with Excel, also Access preferred.
- Demonstrated ability to understand and interpret financial data.
- Experience with contract modeling tool (Harvest and/or Epic preferred).
- Knowledge of Hospital Third Party billing rules.
- Knowledge of managed care contracting and reimbursement methodologies.
- Strong verbal and written communication skills.
- Self starter, able to work independently with ease.
- Demonstrated attention to detail and accuracy.
- Able to prioritize and multitask.
EEO Statement
Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.
Primary Location: MA-Somerville-MGB Assembly Row
Work Locations: MGB Assembly Row, 399 Revolution Drive, Somerville 02145
Job: Finance/Accounting
Organization: Mass General Brigham
Schedule: Full-time
Standard Hours: 40
Shift: Day Job
Posted Shift Description: Eastern Business Hours M-F required with a stable, secure, quiet, compliant work area for remote work.
Employee Status: Regular
Recruiting Department: MGB Revenue Cycle Operations
Job Posting: Nov 13, 2024
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