Analyst, Managed Care Finance
The individual in this position works under direction of Managed Care Finance Supervisor and/or GBC RCM Manager with a primary role of supporting the daily operations of the Managed Care team through timely and accurate loading & maintenance of Managed Care and other contract pricing terms into various contract management and claim pricing systems of Tenet and USPI entities. This individual is expected to perform complex contract analyses and may also function as a liaison between the claims pricing system and Business Office and Managed Care personnel for inquiry and resolution of related items including contract terms, contract performance and payment discrepancies.
- Review and accurately interpret Managed Care contract terms
- Load contract terms into various claims adjudication systems.
- Prepare complex contract analyses as requested with high degrees of accuracy and efficiency
- Works closely with Managed Care Operations team to ensure timely and accurate contract implementation and maintenance.
- Acts as a liaison and collaborates with the claims pricing system and Business Office and Managed Care personnel for inquiry and resolution of related items including contract terms, contract performance and payment discrepancies
- Compliance:
- Adheres to federal, state, and local regulations and accreditation requirements impacting claims pricing systems, Business Office and Managed Care personnel and various contract management and claim pricing systems of Tenet and USPI entities scope of services.
Required:
• Skills required include excellent organizational skills, excellent verbal, and written communication skills, demonstrated problem solving skills, and computer literacy.
• Keen attention to detail and timely follow-through on tasks completion
Preferred:
• Data Analytic skills
Strong knowledge of ambulatory centers such Contracts Management and/or Managed Care Reimbursement or Financial Analysis
Qualifications:
- Bachelor's degree is required.
- Prior healthcare related financial analysis, preferably in Managed Care reimbursement.
- Strong Microsoft Excel knowledge (pivot tables, LOOKUP formulas, etc).
- Knowledge of Google Cloud / Big Query preferred but not required.
- Strong problem solving and analytical skills.
- Familiarity with
- healthcare reimbursement methodologies
- coding (DRG, APC, CPT/HCPCS, ICD-10)
- UB04 and HCFA-1500 bill forms
- Demonstrates a high level of critical thinking.
- Strong organizational skills, including project planning and time management.
- Communicates effectively both verbally and in writing.
