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Senior Managed Care Analyst

2 months ago

Jackson, United States University of Mississippi Medical Center Full time

Hello,

Thank you for your interest in career opportunities with the University of Mississippi Medical Center. Please review the following instructions prior to submitting your job application:

  • Provide all of your employment history, education, and licenses/certifications/registrations. You will be unable to modify your application after you have submitted it.
  • You must meet all of the job requirements at the time of submitting the application.
  • You can only apply one time to a job requisition.
  • Once you start the application process you cannot save your work. Please ensure you have all required attachment(s) available to complete your application before you begin the process.
  • Applications must be submitted prior to the close of the recruitment. Once recruitment has closed, applications will no longer be accepted.
After you apply, we will review your qualifications and contact you if your application is among the most highly qualified. Due to the large volume of applications, we are unable to individually respond to all applicants. You may check the status of your application via your Candidate Profile.

Thank you,

Human Resources

Important Applications Instructions:

Please complete this application in entirety by providing all of your work experience, education and certifications/

license. You will be unable to edit/add/change your application once it is submitted.

Job Requisition ID:
R00038132

Job Category:
Professional and Technical

Organization:
Payor Contracting

Location/s:
Main Campus Jackson

Job Title:
Senior Managed Care Analyst - Payor Contracting

Job Summary:
Supports data driven decision making by formulating recommendations based upon data, trend analysis, financial and operational modeling and strategic market research. Performs a wide variety of duties including working collaboratively with internal stakeholders to drive key managed care initiatives and programs. Provides complex analysis to ensure successful implementation of managed care software and other analytics involved in managed care contract negotiations. Assists in negotiations, re-negotiations and analysis of managed care contracts. Analyzes rate proposals and develops strategies to increase revenue. Responsible for accurate reporting of multiple financial performance reports.

Education & Experience

Education and Experience Required: Bachelor's degree in Accounting, Finance, Healthcare, Business Administration or related field and at least ten (10) years of healthcare experience in Finance, Healthcare, or Managed Care Contracting, or an equivalent combination of education and experience.

Certifcations, Licenses, or Registration Required: N/A.

Knowledge, Skills & Abilities

Knowledge, Skills, and Abilities:

Advanced knowledge of managed care including negotiating, financial analysis, health care reimbursement and modeling of proposed reimbursement as well as interpretation of contract language. Demonstrated technical skills in data analysis and reporting, with the ability to analyze large quantities of data and aggregate information into a digestible report. Ability to develop, implement, and monitor new strategies, policies and procedures. Skilled in organization and time management with the ability to manage multiple projects. Excellent verbal and written communication skills. Ability to build rapport and positive relationships with key stakeholders. Ability to work with little direction while being sensitive to issues requiring supervisory or other stakeholder involvement.

Responsibilities:
  • Prepares monthly, quarterly, annual, and ad hoc financial reports and analyses. Includes monthly payor scorecards for use in joint operation committee meetings with all major commercial payors.
  • Collaborates with Senior Director of Managed Care, and Chief Financial Officer to develop rate structure proposals for payer negotiations.
  • Performs rate modeling for contract negotiations and re-negotiations of contracts.
  • Interprets managed care contracts regarding contract and reimbursement terms, conditions, policies, guidelines and regulations, and keeps them current and accurate in various systems.
  • Communicates with payers regarding items that need clarification and/or price quotes.
  • Updates contract management system with fee schedules and updated payment rates to ensure contracts rate remain current.
  • Quality checks all contract builds in modeling system to validate contract build accuracy aligns with contractual agreement.
  • Maintains managed care contract terms tracking system of all current contracts, agreements and communications with internal and external sources.
  • Identifies appropriate data for system entry, maintenance, retrieval and archiving. Loads and ensures that managed care contracts are entered accurately in various internal systems.
  • Works with others to ensure that data interfacing into specific applications meets departmental business needs.
  • Coordinates with revenue cycle and other financial staff to develop data sets for modeling,
  • Partners with revenue cycle staff to implement annual rate changes to the charge description master (CDM) to maximize payments from payors.
  • Partners with hospital decision support team to develop payer profitability reporting for hospital admissions and surgeries.
  • Reviews and interprets managed care contracts regarding contract and reimbursement terms, conditions, policies, guidelines and regulations, and keeps them current and accurate in various systems.
  • Maintains managed care contract terms tracking system of all current contracts, agreements and communications with internal and external sources.
  • Identifies appropriate data for system entry, maintenance, retrieval and archiving. Loads and ensures that managed care contracts are entered accurately in various internal systems.
  • Works with others to ensure that data interfacing into specific applications meets departmental business needs.
  • The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive.


Physical and Environmental Demands:

Requires occasional working hours significantly beyond regularly scheduled hours, occasional travelling to offsite locations, occasional activities subject to significant volume changes of a seasonal/clinical nature, frequent work produced subject to precise measures of quantity and quality, occasional bending, occasional lifting and carrying up to 50 pounds, occasional climbing, occasional crouching/stooping, occasional driving, occasional kneeling, occasional pushing/pulling, occasional reaching, constant sitting, frequent standing, occasional twisting, and frequent walking (occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more).

Time Type:
Full time

FLSA Designation/Job Exempt:
Yes

Pay Class:
Salary

FTE %:
100

Work Shift:
Day

Benefits Eligibility:
Benefits Eligible

Grant Funded:

Job Posting Date:
08/20/2024

Job Closing Date (open until filled if no date specified):