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Financial Analyst Managed Care II
2 months ago
The Financial Analyst Managed Care II helps manage the ongoing review of actual payor payments versus expected payments through the process of routine retrospective auditing of payments. Responsible for data mining and performing managed care contract analyses for various clients on a regular basis, including summarizing financial trends and impacts for Hospital, Physicians' Organization, and Pediatric Physicians' Organization at Children's Hospital (PPOC). Aides in the development of auditing schedules, tracking mechanisms and coordinating the pursuit of the recovery of net revenue, rebilling of claims and/or settlement opportunities.
The Financial Analyst Managed Care II will be responsible for:
- Designing and building financial models to support various reporting and contracting needs, including payer contract negotiations, developing methodologies, and leveraging internal reporting systems to gather and compile the required data.
- Employing a significant understanding of Hospital/physician contractual reimbursement methodologies and non-fee-for-service arrangements, preparing appropriate analyses for review by various committees and senior leadership, and making recommendations regarding contract terms and fees.
- Performing detailed analyses of various commercial and governmental contract performance, performing patient detail account transaction activity review for payment collection accuracy, completeness, reasonability, interpreting trends or deviations, and making recommendations for corrective action.
- Maintaining and updating the Managed Contract System based on commercial and governmental contracts, performing system set up and testing as necessary to ensure contracts are accurately configured and modeled.
- Assisting Analyst I in compiling quarterly and annual Hospital/physician fee schedules as required by payer contracts, performing contract maintenance analyses as needed by payer, and presenting findings to senior leadership and other internal stakeholders.
- Researching and analyzing financial data for internal and external clients, creating, organizing, and maintaining files using database and spreadsheet programs, retrieving and organizing data into required reporting formats, and collecting, retrieving, and organizing data to identify financial discrepancies and resolve inquiries.
- Developing, preparing, and presenting a variety of ad-hoc reporting, financial models, and analyses for senior leadership as requested.
- Providing functional support to Analyst I including training and reviewing work for accuracy, supporting Senior Analyst for various projects as needed, leveraging Analyst I and Senior Analyst for shared knowledge and expertise, and providing constructive feedback to colleagues in a timely manner to improve output.
- Staffing finance-related Committees, as required.
To qualify you must have:
- Bachelors's Degree
- At least 2 years of related experience in financial analysis, preferably in a Healthcare setting.
- Extensive knowledge of payor contracts and relevant documents to payor reimbursement, coverage and authorization policies.
- Skilled at evaluating contracting analytics by identifying trends and understanding content within the data. Possesses some knowledge of ICD-10, CPT and HCPCS codes, Medicare RVU, and DRG coding methodologies.
- Insight into contracting reporting systems and data output, with the ability to identify opportunities for enhanced practices.
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