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Sr. Managed Care Reimbursement Analyst-REMOTE

Company: Miami Children's Hospital
Location: Miami
Posted on: May 16, 2022

Job Description:

minutes of inactivity. Job Description - Sr. Managed Care Reimbursement Analyst-REMOTE (22710) Job Description Sr. Managed Care Reimbursement Analyst-REMOTE - 22710 Description Job Summary Develops complex contractual reimbursement analysis to support contract negotiations performed by Administrative Director of Managed Care and Payer Strategy. Provides analytics to support the Managed Care objectives of NCHS. - Job Specific Duties

  • Prepares and analyzes contract proposals by evaluating financial impact. -
  • Supports contract negotiations with financial analysis. -
  • Conducts contract audits to identify payer behavior and areas of opportunity. -
  • Obtains and performs regular fee schedule audits of Managed Care Contracts to ensure appropriate level of reimbursement is applied. -
  • Mentors or coaches other analysts in the Financial Analytics team. -
  • Develops and executes complex business plans (including financial models) and project plans to obtain new business growth for the organization. -
  • Assists in ongoing research and maintains working knowledge of payer policies and governmental regulations. -
  • Assists Patient Financial Services Billing and Collections departments in payer policy or reimbursement system audits. -
  • Works cross functionally to operationalize systems and organizational changes required to comply with executed contract requirements.
  • Presents reimbursement results to leaders as needed.
  • Serves as liaison with contract management account representative to drive contract loading, and ensure accurate modeling. - Qualifications
    • Bachelor's Degree in Business Administration, Healthcare Administration, or related field -
    • 4-7 years of experience in managed care and analytics (strategic planning, business development,
    • financial analysis, forecasting, and data modeling) Knowledge, Skills, and Abilities
      • Master's in Business Administration, Healthcare Administration, or related field highly preferred
      • nThrive (previously known as MedAssets), or similar contract management tool system preferred
      • Prior experience using business intelligence system(s)
      • Knowledge of ICD9, ICD10, CPT, DRG and other coding/reimbursement schedules
      • Advanced Excel modeling, formulas, and automation skills
      • Able to create queries and manipulate data results for modeling
      • Ability to communicate verbally and in writing
      • Able to maintain confidentiality of sensitive information
      • Ability to problem solve and formulate a plan of action
      • Able to analyze and audit contracts to identify any opportunities in payment behavior
      • Excellent financial, analytical, communication and organizational skills
      • Experience in bringing together groups with diverse interests and helping groups to build common goals
      • Specific knowledge in a Contract Maintenance Environment for the purpose of Contract Coding and Contracts
      • Knowledge of reimbursement terminology and contract testing
      • Knowledge of healthcare reimbursements in a Managed Care environment
      • Demonstrates competency in financial and statistical reporting, design, preparation of spreadsheets and other financial reports
      • Skills in the use of complex mathematical and statistical techniques to assess financial and statistical scenarios
      • Ability to utilize discretion and independent judgment to support the financial goals of the organization
      • Able to communicate verbal and written information in a clear, concise and easy to understand manner for use by internal and external groups Job : Professional Primary Location Department : NCHS-MANAGED CARE CONTRACTING-1000-900910

Keywords: Miami Children's Hospital, Miami , Sr. Managed Care Reimbursement Analyst-REMOTE, Professions , Miami, Florida

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