Description
This role collaborates closely with the Vice President of Managed Care to support the company and its joint venture hospital partners. Key responsibilities include managing contract databases, interpreting critical contract terms, developing and automating payer contract models, validating data, conducting financial analysis, ensuring federal price transparency compliance, and contributing to annual budgeting and month-end close processes. The position also provides support to Revenue Cycle and Revenue Recognition teams on payer-related issues and contract disputes, while assisting other departments as needed.
The ideal candidate is a proactive self-starter who thrives in a dynamic, fast-paced environment. They possess strong analytical and modeling skills, excellent communication and listening abilities, and a keen intellectual curiosity to identify opportunities for improving departmental efficiency and enhancing company revenue.
Basic Qualifications
- Bachelor's degree in Finance, Accounting, Business Administration, or equivalent experience required.
- Minimum of 3 years of healthcare experience preferred, with deep knowledge of hospital payment methodologies and health plan contracting processes.
- Proven ability to build financial and statistical models, analyze data, and drive actionable results.
- Excellent organizational, written, and verbal communication skills.
- Advanced Microsoft Excel modeling skills (required); proficiency in Word, PowerPoint, and Outlook (essential).
- Ability to write efficient queries for data retrieval, filtering, and manipulation using SQL
- Intermediate knowledge of data preparation and visualization techniques using PowerBI
- Strong analytical and problem-solving capabilities.
- Comfortable working in a fast-paced environment with minimal supervision.
- Ability to meet deadlines while managing multiple projects and delivering high-quality work.
- Detail-oriented with a strategic, big-picture mindset.
Essential Job Functions
- Serve as the managed care liaison and subject matter expert for joint venture hospital partners, revenue cycle billing and collections teams, and finance department leaders.
- Compile and analyze payer performance metrics for reporting to organizational leadership.
- Maintains up-to-date managed care contract databases to streamline collections, support analysis, and share contract terms efficiently.
- Assist the revenue cycle team by loading and maintaining current payer rates in an insured allowed/payment validation module.
- Perform random audits of claim payments to ensure payer compliance with managed care agreements.
- Support special projects, including claim data analysis for contract negotiations, service line research, and pro formas for new market opportunities.
- Build contract models to assess current performance yields and evaluate new contract proposals.
- Collaborate with the revenue cycle team to identify underpaid/overpaid claims and develop initiatives to secure accurate payments.
- Provide managed care insights and contract modeling (e.g., rate escalators, charge master updates, new contract yields) to support the finance team's annual budget process.
- Aid the revenue recognition team during month-end close by offering managed care perspectives on key revenue-influencing items.
- Ensure compliance with federal and state price transparency regulations by preparing and maintaining required files.
- Represent managed care in joint venture board meetings or monthly operational reviews as required.
- Conduct financial data analysis and respond to internal/external inquiries from management.
Other Job Functions
- Provide clear explanations and actionable recommendations on managed care topics.
- Contribute to cross-functional projects with Finance, Operations, Revenue Cycle, and Business Development, delivering ad-hoc analysis as needed.
- Attend required staff meetings, company-sponsored events, or mandated gatherings.
- Take ownership of personal professional development.
- Perform additional duties as assigned.
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