Financial Analyst - Managed Care

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

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources.