Managed Care Contract Analyst I

3 weeks ago

Boston, United States Boston Children's Hospital Full time
Job Posting Description

At Boston Children's Hospital, the quality of our care - and our inclusive hospital working environment - lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices are heard and ideas are shared. Join us, and discover how your unique contributions can change lives. Yours included.

The Managed Care Contract Analyst I assists in managing the ongoing review of actual payor payments versus expected payments through the process of routine retrospective auditing of payments. Assists with 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. Helps identify over and underpayments based on contract intent. Extensive knowledge of payor contracts and relevant documents to payor reimbursement, coverage and authorization policies.

The Managed Care Contract Analyst I will be responsible to:

  • Design and build simple financial models to support various reporting and contracting needs. Work with other departments within the organization and leverage internal reporting systems to gather and compile the required data.
  • Employ basic understanding of Hospital/physician contractual reimbursement methodologies. Prepare appropriate analyses for review by various committees and senior leadership.
  • Prepare monthly, quarterly and yearly payer contract performance reports. Prepare and distribute monthly reports for financial close process, consistently following established procedures for formatting and accuracy.
  • Maintain and update Managed Contract System based on commercial and governmental contracts. Perform system setup and testing as necessary to ensure contracts are accurately configured and modeled.
  • Compile quarterly and annual Hospital/physician fee schedules as required by payer contracts. Distribute fee schedules to internal and external clients as needed. Maintain organized and welldocumented project files.
  • Develop, analyze, and present financial models for internal and external clients. Organize and maintain files using database and spreadsheet programs in required reporting formats.
  • Provide functional support to Analyst II and Senior Analyst for various projects as needed.

To qualify, you must have:

  • Bachelor's degree, preferably Business/Finance/Economics/Statistics or a related STEM field is required and 1-2 years of work experience strongly preferred
  • A willingness and ability to learn about healthcare data sets and data systems, financial reporting and modeling, and external market dynamics
  • Ability to organize and document variables, assumptions, and data sources
  • Ability to follow standardized processes accurately and consistently
  • Familiarity with MS Office applications, in particular Excel. Technical skills in executing common Excel formulas (sum, if, Vlookup, pivot tables)
  • Ability to communicate effectively both orally and in writing, and provide empathy in difficult interpersonal situations
  • This position is 100% remote, with the opportunity for a flexible work schedule

Boston Children's Hospital offers competitive compensation and unmatched benefits including flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

#LI-Remote

Boston Children's Hospital requires all employees to be vaccinated against COVID-19 and Flu, (unless you are eligible for a medical or religious exemption).

Boston Children's Hospital is an Equal Opportunity / Affirmative Action Employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.

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