Senior Managed Care Analyst
2 weeks ago
The Senior Managed Care Analyst will collect and analyze data on costs, charges and utilization to support negotiations with managed care companies. Will develop and implement appropriate tools to expedite effective evaluation and monitoring of managed care contract performance and service utilization.
Qualifications:
Minimum Education
Bachelor's Degree Business, Accounting, Health Care Administration, Economics or Mathematics. (Required)
Master's Degree (Preferred)
Minimum Work Experience
3 years Relevant work experience in financial and/or utilization analysis. (Required)
Required Skills/Knowledge
Proven analytical skills including ability to make recommendations based on financial analyses.
Superior PC skills including proficiency in word, spreadsheet analysis and database management.
Experience with financial and utilization analysis.
Ability to work in a team environment with other analysts, managers, and physicians.
Strong communication and organizational skills.
Proficiency in presentation of analytical results.
Previous experience in health care is highly desirable, including experience with hospital/physician information and patient accounting information systems.
Functional Accountabilities
Contract Provisions Assessment
- Develop reports to assess existing contracts by type of service.
- Develop models to assess impact of alternative contract rates to support negotiations.
- Provide updated reports for inpatient and outpatient service categories.
- Complete ad hoc reports for individual payors as needed.
- Provide routine reports to monitor plan utilization and contract performance.
- Provide comprehensive reports for evaluation of FY results.
- Provide analysis of cost information using available cost tables.
- Speak up when team members appear to exhibit unsafe behavior or performance
- Continuously validate and verify information needed for decision making or documentation
- Stop in the face of uncertainty and takes time to resolve the situation
- Demonstrate accurate, clear and timely verbal and written communication
- Actively promote safety for patients, families, visitors and co-workers
- Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance
Quality Assurance
- Review rules and identify problem areas to assure expected payments are correct.
- Partner in the mission and upholds the core principles of the organization
- Committed to diversity and recognizes value of cultural ethnic differences
- Demonstrate personal and professional integrity
- Maintain confidentiality at all times
- Anticipate and responds to customer needs; follows up until needs are met
- Demonstrate collaborative and respectful behavior
- Partner with all team members to achieve goals
- Receptive to others' ideas and opinions
- Contribute to a positive work environment
- Demonstrate flexibility and willingness to change
- Identify opportunities to improve clinical and administrative processes
- Make appropriate decisions, using sound judgment
- Use resources efficiently
- Search for less costly ways of doing things
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