Supports Managed Care leadership in financial modeling.
Basic knowledge of contractual language as it relates to reimbursement methodologies
Applies basic understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and revenue codes
Demonstrates knowledge of various reimbursement methodologies including, Per Diem, DRG, fee schedules, and percent of charge
Demonstrates knowledge of commercial payers for modeling and analyzing contract proposals
Performs analytical and planning functions in support of Managed Care decision making
Participates in the annual Managed Care revenue budget process
Utilizes a variety of software applications and data sources to produce the Managed Care Suite, DAA reports, other standard reporting, and adhoc reports
Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance
Supports Senior Managed Care Analyst in timely and efficiently completing financial analyses related to Managed Care net revenue.
Completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by Leadership
Adapts to new situations and changing priorities to accomplish project deadlines and department goals
Demonstrates strong project management and organizational skills by maintaining up-to-date project lists to assist in setting appropriate project priorities
Applies technical expertise in the development of models and decision support information
Assures the application of appropriate standards of data analysis and that all analytics are quality checked
Develop an understanding of reimbursement methodologies and their impact on internal systems and other departments
Fully documents the process required to replicate any analytic process undertaken
Contributes to the overall completion of the work product in group project situations
Maintains and utilizes available resources to ensure work is completed accurately and timely
What You Will Need:
Education and Experience Required:
Associates Degree in Business, Accounting, Finance, Information Systems, or related.
1-3 years of experience in managed care, patient billing services, health insurance claims processing, contract management, finance, or accounting
Knowledge and Skills Required:
Microsoft Office (Excel PowerPoint, Word, Outlook, Visio, etc.)
Excellent verbal and written communication skills
Excellent problem-solving skills
The Managed Care Analyst applies technical, analytical, and problem-solving skills to provide solutions/improvements within the department. Responsible for completing financial and/or operational analysis of contracts, developing and tracking key performance indicators, financial modelling comparative analysis and bench marking. This person demonstrates competences in decision support and reporting through converting raw data into useful and actionable information. This person is responsible for compiling and analyzing data as well as for creating meaningful applications to support executive decision making. Character traits include: strong work ethic, trainability, communicative, team player all with a positive “can do” attitude. Intermediate Excel skills required.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.