Contract Analyst, Managed Care

3 weeks ago

Janesville, United States Mercy Health System Full time

Overview:

  • Managed Care Contract Analyst, Days, 80 Hrs / 2 wks
  • Location: Mercycare Bldg, Janesville, WI OR Rockton Ave Campus, Rockford, IL. Hybrid, flexible work schedule, and remote opportunities available. Mercyhealth does not currently support remote workers with residency in the following states: CA, OH, OR, PA, NJ, NY.

Under the direction of the Managed Care Director and Managed Care Manager the Managed Care Contracting Analyst will support Managed Care contracting, and maintain the development of standard and sustainable contract build, contract modeling, training, and project management related to root cause mitiation. The Managed Care Contracting Analyst is responsible for providing support to the Managed Care Contracting team, providing training to new Managed Care Contracting partners as well as ongoing training to existing Managed Care Contracting partners, and for the performance of analytic functions within the managed care contracting process, including comprehensive data analysis, financial and operational projects. Additionally, this position is responsible for building and the maintenance of managed care contractual terms within the Epic system.The Analyst will monitor the use of the Epic contracts at a high level to determine if the Payor contracts are built efficiently and on time.

Responsibilities:
  • Provides contracting support for Mercyhealth managed care contracting initiatives, to include review of all contract and amendment proposals. Assists with providing oversight for all managed care contractual terms building, testing, and production within Epic or other ancillary systems. Provides support for contract negotiations, including measurement of results. Serves as subject matter expert with regards to Mercyhealth managed care contracts.
  • Works corroboratively with system-wide personnel in the implementation of system managed care agreements. These duties may include but are not limited to identifying training needs, reporting needs, and the ongoing management and administration of agreements.
  • Builds and maintains all current and updated managed care contractual terms within Epic; tests all ongoing models to assure contract payment accuracy and integrity. Monitors creation and completion mapping for all new payer/plans for Mercyhealth in Epic. Interfaces with other Revenue Cycle areas to identify and resolve issues. Provides recommendations for Epic contract maintenance and the development of new tools to support contracts and model build.
  • Collaborates with all Revenue Cycle and other areas on researching and resolving contract variances and discrepancies. Works the various underpayment and overpayment work queues, and submits reconsiderations and/or appeals as necessary. Consults as needed with clinical and operational teams on managed care initiatives. Leads consulting efforts with the Information Systems department regarding Epic contracting.
  • Provides training to new partners, and provides ongoing training to existing partners within the Managed Care Contracting department. Assists in the development of departmental training materials.
  • Performs audits of contract build in Epic.
  • Keep current of ICD-10 and CPT coding requirements
  • Content expert for contract terms and all payment methodologies for hospital, physician, and ancillary entities (DRGs, APCs, RUGs, surgical groupers, service line careveouts, physician fee schedules, locality indexes, and all cost reports
  • Participates in educational programs to meet mandatory requirements and identified needs with regard to position and personal growth.
  • Additional duties as assigned or appropriate


Education and Experience:

Bachelor's degree in finance, business, or healthcare administration and 3 years' experience working in revenue cycle, denials management and contract management required. 8 years of experience in lieu of degree.

Three years of progressive work in Contract Management is required.

Exposure to project management is preferred.

Certification/Licensure:

Required to obtain one of the following Epic certifications: Professional Billing Reimbursement Contracts or Resolute Hospital Billing Contracts within one year.

Special Physicial Demands:

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is regularly required to walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; and talk or hear. The employee is frequently required to sit and work at a computer for long periods of time. The employee is occasionally required to stand. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. While performing the duties of this job, the employee must have good manual dexterity to operate keyboard and telephone; repetitive finger/wrist movement associated with use of keyboard; prolonged sitting. The employee must be able to lift or move office related object

Culture of Excellence Behavior Expectations:

  • Contract Analyst Managed Care

    2 weeks ago

    Janesville, United States Mercy Health System Full time

    JOB REQUIREMENTS: Overview Managed Care Contract Analyst, Days, 80 Hrs / 2 wks Location: Mercycare Bldg, Janesville, WI OR Rockton Ave Campus, Rockford, IL. Hybrid, flexible work schedule, and remote opportunities available. Mercyhealth does not currently support remote workers with residency in the following states: CA, OH, OR, PA, NJ, NY. Under the...

  • Inventory Manager/Analyst

    3 days ago

    Janesville, United States Phelps Industries LLC Full time

    Job DescriptionJob DescriptionJob descriptionPhelps Pet Products is a highly regarded branded and contract manufacturer of specialty meat-based pet treats. Founded over 55 years ago, Phelps Pet Products has earned a well-deserved reputation as a trusted and innovative partner to some of the best-known and best-loved brands in the market! We provide...

  • Registered Nurse Quality Data Analyst

    2 weeks ago

    Janesville, United States Mercy Health System Full time

    JOB REQUIREMENTS: Overview Provides compassionate, culturally sensitive, holistic nursing care to patients in a clinical setting, supporting the Mercyhealth nursing mission, practice values and strategic plan. May include variable shifts, weekends, holiday and/or on-call hours. Performs other duties as assigned including floating to various units based on...

  • System Analyst Clinical

    4 days ago

    Janesville, United States Mercy Health System Full time

    Overview Hybrid - with in 90 minutes of driving Open to an RN or Non RN Partner The System Analyst Clinical 1position supports and maintains software applications that impact clinical areas, such as ambulatory clinics, IP hospital depts., pharmacy, and physician documentation. This role provides analytical and application support in the areas of planning,...

  • Data Analyst

    2 weeks ago

    Janesville, United States Data Dimensions Full time

    Purpose: The Data Analyst will be an integral part of the Data Team in building and scaling processing capabilities, data analysis and reporting. This role will center around supporting inbound data operations and mining complex data for valuable insights to support the team in making high quality, data driven decisions. Essential Duties and...

  • Registered Nurse Quality Data Analyst

    3 days ago

    Janesville, United States Mercy Health System Full time

    Overview: Provides compassionate, culturally sensitive, holistic nursing care to patients in a clinical setting, supporting the Mercyhealth nursing mission, practice values and strategic plan. The Quality Data Analyst facilitates quality assessment and improvement activities for the medical staff and health system quality initiatives. The Data Analyst...

  • Financial Analyst

    4 days ago

    Janesville, United States SSI Technologies, LLC Full time

    Position Summary: The Financial Analyst II is responsible for analyzing financial data and providing insights to support decision-making and strategic planning within SSI. The position will assess financial performance, create financial models, and make recommendations to improve profitability and efficiency. The Financial Analyst will also monitor...

  • Financial Analyst

    3 days ago

    Janesville, United States SSI Technologies Full time

    Position Summary: The Financial Analyst II is responsible for analyzing financial data and providing insights to support decision-making and strategic planning within SSI. The position will assess financial performance, create financial models, and make recommendations to improve profitability and efficiency. The Financial Analyst will also monitor...

  • Business Analyst Mercycare Certified

    2 weeks ago

    Janesville, United States Mercy Health System Full time

    JOB REQUIREMENTS: Overview Configures medical and pharmacy benefit packages, premium billing, finance, eligibility and customer service sub-system reference files using the managed care software provided by Epic. Designs, develops and maintains uniform and customized benefit packages for all insurance products, including HMO, PPO, POS, HSA, EPO, Medicaid and...

  • Behavioral Analyst Board Certified, Autism Clinic

    4 days ago

    Janesville, United States Mercy Health System Full time

    Overview Now including a Sign on bonus up to $10,000!! Supervises, coordinates and monitors staff training and the oversight of the care for patients with behavioral treatment needs. This may be within the Behavioral Health Department. : Clinic, Hospital, EAP Services and/or Child Services~, CADT ~ Autism In-Home or a combination of multiple areas. The...

  • Youth Care Worker

    4 weeks ago

    Janesville, United States Christian Servants Home Care Full time

    **Possible Responsibilities**: **Companion Care**: Providing emotional support and companionship to clients. **Meal Preparation**: Prepare nutritious meals based on client preferences and dietary needs. **Transportation**: Safely transport clients to/from appointments and social outings (mileage reimbursement provided). **Respite Care**: Provide relief...

  • Demand Planning Manager

    5 days ago

    Janesville, United States Blain's Farm & Fleet Full time

    Job Description At Blain’s Farm & Fleet we believe everyone deserves the opportunity to have a job they love, work in a great environment, grow their career, and enjoy a positive balance. As a family-owned retailer we take pride in offering a competitive benefit package designed to support you & your life. It is one of the reasons we have been...

  • Property Manager

    1 week ago

    Janesville, United States Cardinal Capital Management Full time

    Overview: **Duties**: - Manage all aspects of assigned property, leasing, budgeting, and tenant relations - Ensure compliance with Fair Housing regulations, LIHTC, Section 8, and other applicable laws - Negotiate contracts with vendors and service providers for property maintenance and facilities management - Utilize OneSite or similar software for property...

  • IT Program Manager

    2 weeks ago

    Janesville, United States GlobalSource IT Full time

    We are currently seeking a qualified candidate for a hybrid position near Janesville, WI.Our client is looking for an IT Program Manager for a 7 month, through the end of year, contract role. The start date is in the next 3 to 4 weeks and the role requires a minimum of 2 days onsite per week.Job Details: Our client is looking for an IT Program Manager (10+...

  • Travel Nurse RN

    3 days ago

    Janesville, United States LanceSoft Full time

    LanceSoft is seeking a travel nurse RN Med Surg for a travel nursing job in Janesville, Wisconsin.Job Description & RequirementsSpecialty: Med SurgDiscipline: RNStart Date: 06/17/2024Duration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelPerks: Medical & Health Insurance Benefits from First Day for All Clinical and Patient-Facing...

  • Field Specialist

    5 days ago

    Janesville, United States BrightStar Care Full time

     Job Description Summary:The Field Specialist is responsible for providing care for our clients as needed during their assigned schedule. This position is responsible for starting new cases, filling in for current caregivers, training new employees, and being a mentor to our field team. The Field Specialist will be expected to go to all assigned shifts in...

  • Field Specialist

    4 days ago

    Janesville, United States BrightStar Care Full time

     Job Description Summary:The Field Specialist is responsible for providing care for our clients as needed during their assigned schedule. This position is responsible for starting new cases, filling in for current caregivers, training new employees, and being a mentor to our field team. The Field Specialist will be expected to go to all assigned shifts in...

  • Physician Medical Director for MercyCare Health Plan in Janesville, WI

    1 week ago

    Janesville, United States Mercyhealth (FKA Mercy Health System) Full time

    The critical thought leader we select for this important role will be accountable for identifying and promoting key strategies for continuously improving the outstanding quality and efficiency of care expected by our members. In addition to controlling costs through utilization management, case management, disease management and other strategies, this...

  • Physician Medical Director for MercyCare Health Plan in Janesville, WI

    2 months ago

    Janesville, United States Mercyhealth (FKA Mercy Health System) Full time

    The critical thought leader we select for this important role will be accountable for identifying and promoting key strategies for continuously improving the outstanding quality and efficiency of care expected by our members. In addition to controlling costs through utilization management, case management, disease management and other strategies, this...

  • Travel Nurse RN

    5 days ago

    Janesville, United States LanceSoft Full time

    Job DescriptionLanceSoft is seeking a travel nurse RN Med Surg for a travel nursing job in Janesville, Wisconsin.Job Description & RequirementsSpecialty: Med SurgDiscipline: RNStart Date: 06/16/2024Duration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelPerks: Medical & Health Insurance Benefits from First Day for All Clinical and...