Financial Analyst - Managed Care
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Job Summary
Provides data retrieval / contract modeling / financial analysis support to Director, VP, and Managed Care Regional Contracting Directors.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Retrieves reimbursement data from hospital and physician accounting systems.
- Builds financial models to analyze and evaluate the reimbursement impact of hospital and physician payer reimbursement methodology proposals
- Works with Managed Care Regional Contracting Directors on contract interpretation issues to ensure accuracy of contract models and financial analysis.
- Produces clear and concise written reports summarizing payment modeling analysis.
- QA monthly data loads.
- Completes special projects/reports as needed
Qualifications:
- Well versed in reimbursement methodology including DRG, APC, COPPS, OPPS, Case Rates, Per Diems, HCPCS and CPT Code Fee Schedules (2-5 years’ experience).
- Familiar with hospital and physician billing and coding terminology including diagnostic codes, revenue codes, procedure codes, and HCPCS codes.
- Well versed in healthcare product lines including HMO, PPO, HIX, Medicare, Medicaid, Tricare, Workers Comp.
- Must be able to clearly communicate complex and technical issues in writing and verbally.
- Must have the ability to work independently and manage multiple projects simultaneously
Computer Skills:
To perform this job successfully, an individual should have knowledge of
- Word Processing software
- Exceptional skills in Excel.
- Knowledge of contract modeling systems such as FinThrive preferred.
- Knowledge of Access or SQL preferred.
Education/Experience:
- Bachelor’s degree required; emphasis in Accounting or Data Analytics preferred
- 2-5 years’ work experience required
- Prior experience in hospital, physician or health plan financial analysis, or equivalent experience preferred
- Knows/has modeled/worked with health plan/hospital and physician managed care commercial and Medicare reimbursement methodologies and terminology