Managed Care Analyst
Wage Range:
$68,764 - $110,032 per yearPosted wage ranges represent the entire range from minimum to maximum.
For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level.
Some positions also offer additional premiums based on shift, certifications, or degrees.
Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
This position can workHybrid remote/in-office.
Job SummaryResponsible for coordinating and completing the data reporting and analytical needs for the Contracts Management Department.
Provides complex, advanced evaluation of proposed and contracted payer rates by utilizing Epic reporting, 3M coding grouper software, Alliance Decision Support (ADS) system and other analytical tools including Microsoft Access and Excel, as needed.
Directly supports department leadership in all payer and health plan contract negotiations for all EvergreenHealths divisions (both hospitals, medical group, home care/hospice, ambulatory surgery center) through detailed scenario modeling, comparative analysis, and benchmarking.
Assists in the monitoring of contract performance in Epic and Alliance Decision Support, tracks key contract statistics for regular, periodic reporting, completes ad hoc analysis to support business needs, and provides primary assistance in the development of specific contracting strategies.
Primary DutiesFunctions as lead for Managed Care Analyst group as needed.
Understands and interprets contract terms, reimbursement schedules, patient accounting system(s) and other sources of data to complete analyses and financial projections.
Builds complex data models used for contract rate negotiations with payers.
Summarizes impact of proposals for department leadership and provides detailed analysis if necessary.
Develops and completes specialized statistical and financial analysis reports on payer volumes, payments, contractual adjustments, administrative fees, etc.
Assists other managed care analyst(s) as needed for maintenance of contract terms in Epic.
Facilitates maintenance of necessary grouper software/systems as applicable for the various EvergreenHealth entities, types of billed claims and patient-types.
Completes ad hoc reporting as needed, e.
g.
, pro forma, new business development, etc.
Tracks various value-based care (VBC) contract payments, including shared-savings, incentives, and capitation.
Completes reconciliation reporting validation as needed for VBC contracts.
Collaborates with finance team and participates in the annual budgeting process, as it relates to system revenue changes.
Participates in the development of the contract negotiation strategy including various reference reports, benchmarking parameters, etc.
Prepares summary narrative reports, graphs, tables, charts, and illustrations.
Assists with implementation of new contracts and reporting.
Assists in data collection for the completion of necessary payer credentialing applications for EvergreenHealth.
Performs other duties as assigned.
License, Certification, Education or
Experience:
REQUIRED for the position:
Bachelors degree in finance, business, or health administrationExperience with patient accounting and claims billing and associated codesComplex business modeling, statistical and trending skillsProven experience in financial/business analysisExperience with Alliance Decision Support system or equivalentDESIRED for the position:
Masters degree (MBA or MHA)Minimum of 5 years of experience with health care, financial analysis and/or managed care contractsExperience with health insurance operations and payment methodologiesBenefit Information:
Choices that care for you and your familyAt EvergreenHealth, we appreciate our employees commitment and contribution to our success.
We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.
Medical, vision and dental insuranceOn-demand virtual health careHealth Savings AccountFlexible Spending AccountLife and disability insuranceRetirement plans (457(b) and 401(a) with employer contribution)Tuition assistance for undergraduate and graduate degreesFederal Public Service Loan Forgiveness programPaid Time Off/VacationExtended Illness Bank/Sick LeavePaid holidaysVoluntary hospital indemnity insuranceVoluntary identity theft protectionVoluntary legal insurancePay in lieu of benefits premium programFree parkingCommuter benefitsView a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.
2023 Benefits GuideIND123Please see job descriptionPI224863914 Recommended Skills Accounting Administration Billing Business Analysis Business Development Business Requirements Estimated Salary: $20 to $28 per hour based on qualifications.
$68,764 - $110,032 per yearPosted wage ranges represent the entire range from minimum to maximum.
For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level.
Some positions also offer additional premiums based on shift, certifications, or degrees.
Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
This position can workHybrid remote/in-office.
Job SummaryResponsible for coordinating and completing the data reporting and analytical needs for the Contracts Management Department.
Provides complex, advanced evaluation of proposed and contracted payer rates by utilizing Epic reporting, 3M coding grouper software, Alliance Decision Support (ADS) system and other analytical tools including Microsoft Access and Excel, as needed.
Directly supports department leadership in all payer and health plan contract negotiations for all EvergreenHealths divisions (both hospitals, medical group, home care/hospice, ambulatory surgery center) through detailed scenario modeling, comparative analysis, and benchmarking.
Assists in the monitoring of contract performance in Epic and Alliance Decision Support, tracks key contract statistics for regular, periodic reporting, completes ad hoc analysis to support business needs, and provides primary assistance in the development of specific contracting strategies.
Primary DutiesFunctions as lead for Managed Care Analyst group as needed.
Understands and interprets contract terms, reimbursement schedules, patient accounting system(s) and other sources of data to complete analyses and financial projections.
Builds complex data models used for contract rate negotiations with payers.
Summarizes impact of proposals for department leadership and provides detailed analysis if necessary.
Develops and completes specialized statistical and financial analysis reports on payer volumes, payments, contractual adjustments, administrative fees, etc.
Assists other managed care analyst(s) as needed for maintenance of contract terms in Epic.
Facilitates maintenance of necessary grouper software/systems as applicable for the various EvergreenHealth entities, types of billed claims and patient-types.
Completes ad hoc reporting as needed, e.
g.
, pro forma, new business development, etc.
Tracks various value-based care (VBC) contract payments, including shared-savings, incentives, and capitation.
Completes reconciliation reporting validation as needed for VBC contracts.
Collaborates with finance team and participates in the annual budgeting process, as it relates to system revenue changes.
Participates in the development of the contract negotiation strategy including various reference reports, benchmarking parameters, etc.
Prepares summary narrative reports, graphs, tables, charts, and illustrations.
Assists with implementation of new contracts and reporting.
Assists in data collection for the completion of necessary payer credentialing applications for EvergreenHealth.
Performs other duties as assigned.
License, Certification, Education or
Experience:
REQUIRED for the position:
Bachelors degree in finance, business, or health administrationExperience with patient accounting and claims billing and associated codesComplex business modeling, statistical and trending skillsProven experience in financial/business analysisExperience with Alliance Decision Support system or equivalentDESIRED for the position:
Masters degree (MBA or MHA)Minimum of 5 years of experience with health care, financial analysis and/or managed care contractsExperience with health insurance operations and payment methodologiesBenefit Information:
Choices that care for you and your familyAt EvergreenHealth, we appreciate our employees commitment and contribution to our success.
We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.
Medical, vision and dental insuranceOn-demand virtual health careHealth Savings AccountFlexible Spending AccountLife and disability insuranceRetirement plans (457(b) and 401(a) with employer contribution)Tuition assistance for undergraduate and graduate degreesFederal Public Service Loan Forgiveness programPaid Time Off/VacationExtended Illness Bank/Sick LeavePaid holidaysVoluntary hospital indemnity insuranceVoluntary identity theft protectionVoluntary legal insurancePay in lieu of benefits premium programFree parkingCommuter benefitsView a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.
2023 Benefits GuideIND123Please see job descriptionPI224863914 Recommended Skills Accounting Administration Billing Business Analysis Business Development Business Requirements Estimated Salary: $20 to $28 per hour based on qualifications.
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