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