Managed Care Analyst

3 weeks ago

Carbondale, United States Southern Illinois Health Full time

Overview:

Your Career. Our Company. Together, We Grow.

At Southern Illinois Healthcare (SIH), we realize that in order to provide our surrounding communities with excellent care, we must begin by providing our employees with that same care and appreciation. We offer rich opportunities to develop and grow professionally, an environment of excellence in patient care, and the awareness that everything we accomplish is a direct outgrowth of the superb efforts and dedication of our employees.

As a non-profit system of almost 4000 employees, we have won national acclaim for our cancer, cardiac, stroke, bariatric, breast imaging, and rehabilitation services.

$58,115.20/yr minimum - $87,110.40/yr maximum (range increases based on education, experience and certifications)

Responsible for providing analysis and performance monitoring to maximize financial potential of payor contracts, value based programs, and PHO network

Responsibilities:
Job Roles

Safety

    • Manages processes effectively in regard to employee/patient safety.

Record Keeping

    • Maintains all required records, reports, statistics, logs, files and other documents as required.

Process Improvement

    • Promotes a culture of process improvement by participating in unit/department based programs that supports the systems process improvement goals.
    • Actively participates on system-wide or hospital-based teams as needed.

Role Specific Responsibilities

    • Provide trending, monitoring, and reporting to maximize financial
    • Perform strategic data analysis/data mining and research findings as appropriate to support business needs.
    • Analyze data in focus areas and compare to industry standards, then initiate improvement processes when applicable.
    • Review requests from customers and suggest improvements or
    • Maintain high level of knowledge for assigned reporting and decision support systems to provide adequate levels of user performance.
    • Validate data in various reporting systems and investigate data issues to determine root cause, then initiate resolution as needed.
    • Manage relationships with payors, affiliated providers, customers, end users, core teams, management, IT staff, vendors, and others to actively engage all parties seeking the best approach to resolving barriers and system issues.
    • Monitor federal regulations governing contracting and insurance, clinical integration, advanced payment models, and revenue cycle.
    • Maintain industry knowledge related to healthcare reimbursement trends, including value-based payment and subsequent risk models.
    • Managed data requests and prioritize
    • Suggest process improvement for administrative
    • Attend and facilitate meetings as
    • Assist with other projects as

Commercial Payor Analyst

  • Responsible for implementation and ongoing performance monitoring of all commercial payor contracts.
  • Provide reporting and analysis for contract performance
  • Maintain contract terms in applicable contract management
  • Perform contract modeling and support payor
  • Serve as department representative for SIH service line and revenue cycle
  • Research payor policies and newsletter updates, monitoring for impact to


Qualifications:

Education

  • Bachelors degree in Finance, Business Administration, Healthcare Management or other related field.

Licenses and Certification

  • N/A

Experience and Skills

  • Technical Experience: 3 years

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