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Analyst-Financial, Mgd Care

4 months ago

Gainesville, United States Northeast Georgia Health System Inc Full time

Job Category:

Accounting & Finance, Information Technology

Work Shift/Schedule:

8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

Performs a wide range of complex managed care analytical and operational functions. Performs office procedures in support of managers. This position is responsible for managed care financial analysis, modeling and analyzing contract proposals, contract loading in both the Epic contract applications and the contract management system. This position is responsible for providing system-level support for Epic contract applications which include technical build, configuration, migration, maintenance and production support. This position works on complex problems where analysis of situations or data requires an in-depth evaluation and knowledge of the contract application. This person may also assist with contract negotiation processes as needed, make recommendations to the Managed Care negotiators regarding terms of the contract. This person will act as a liaison between contract management platform system administrators, IT Analysts and leadership, Revenue Cycle, and the Managed Care negotiators for resolution and feedback of any related items. This person may work with managed care payors to resolve claims and related issues in order to enhance managed care contract performance. Supports multiple managed care functions, including but not limited to Epic data integrity, contract management system integrity, managed care contract negotiations, and managed care payer relations, including both claim and operational issues, all in support of the Health System revenue cycle function. This position provides reports for the Medical Economics Manager and/or Contracts Integrity Managers concerning payment variance issues.

Remote Position Must Reside In Georgia

Minimum Job Qualifications

  • Licensure or other certifications: Epic Resolute Hospital Billing Expected Reimbursement Contracts Management Certification
    Epic Resolute Hospital Billing Expected Reimbursement Contracts Administration Certification

  • Educational Requirements: Bachelors Degree

  • Minimum Experience: Bachelors Degree and two (2) years of related managed care contracting and/or billing/collection experience in a hospital and/or managed care payor setting; or in lieu of Bachelors Degree five (5) + years of relevant experience

  • Other:

Preferred Job Qualifications

  • Preferred Licensure or other certifications:

  • Preferred Educational Requirements:

  • Preferred Experience: Epic Resolute HB/PB contract build experience

  • Other:

Job Specific and Unique Knowledge, Skills and Abilities

  • Able to understand and interpret Managed Care Contracts. Research, collect, and analyze contract information as required

  • Ability to accurately build contracts into the contract management system and Epic contract applications

  • Demonstrates well developed and proven organizational, problem solving, analytical and time management skills

  • Demonstrates competent technical skills with the ability to troubleshoot complex issues

  • Demonstrates strong communication skills, both written and verbal

  • Demonstrates leadership skills by mentoring other team members and resolving complex problems.

  • Strong mathematical, analytical, and contract management skills including a thorough understanding of how to interpret contract language and reimbursement terms and translate them into accurate calculations in both Epic and the contract management system

  • Must be able to function in a dynamic environment subject to changes in schedules and priorities, working on multiple projects/issues concurrently

  • Able to develop and maintain good working relationships and to interact positively and productively with teams within the department and outside of the department

  • Ability to improve work processes

  • Knowledge of Microsoft and other analytical tools

  • Knowledge of Managed Care or similar reimbursement areas

  • Demonstrates an understanding of billing practices, specifically Revenue codes, CDM codes and ICD-10 codes

  • Knowledge of the contract negotiation process

  • Ability to comply with confidentiality rules, polices, and regulations.

  • Demonstrates a knowledge of the changes in the healthcare industry and federal regulations to ensure the contracts applications reflect the most up to date Medicare terms

Essential Tasks and Responsibilities

  • Models contracts to determine appropriate financial terms.

  • Identifies, analyzes, and resolves financial calculation issues between payer and provider.

  • Possess a specific knowledge of Third-Party Healthcare Arrangements and is able to apply that knowledge.

  • Calculates and audit expected reimbursement in order to determine accuracy of payment.

  • Acts as a “System Administrator.”

  • Determines appropriate payment classifications determination and record it accurately in the system.

  • Continually seeks ways and means for improving the delivery and support of Managed Care Modeling & Reimbursement System feedback.

  • Is aware of process flow(s) across all Revenue Cycle departments, and involves them, as appropriate, when recommended actions may impact their work functions.

  • Works collaboratively with system users, technical staff, other ITS groups in solving complex problems.

  • Works with project managers and ITS groups during system upgrades and enhancement of current system functionality related to contract applications.

  • Provides support for installation, configuration, maintenance, reporting and production support for contract applications.

Physical Demands

  • Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

  • Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

  • Vision: Heavy, Constantly 66-100% of time

  • Kneeling/Stooping/Bending: Occasionally 0-30%

  • Standing/Walking: Occasionally 0-30%

  • Pushing/Pulling: Occasionally 0-30%

  • Intensity of Work: Occasionally 0-30%

  • Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.


NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.