Managed Care Analyst I

About the role

Responsible for the collection and reconciliation of underpayments on managed care contracts. Maintains a log of the current status of underpayments collected. Maintains and continually updates the department training manual. Provides a weekly and a monthly report of collections to the Manager. Responsible for completion of projects that are pro-active and focused on problem areas and high cost services to ensure maximum contractual reimbursement. Responsible for understanding the reimbursement methods by contract and knowledge of PMMC for contract management reporting. Responsible for developing a strong relationship with insurance carriers in order to address multiple underpayments by a given payer.

Responsibilities

• Maintains a log of the current status of underpayments collected.
• Maintains and continually updates the department training manual.
• Provides a weekly and a monthly report of collections to the Manager.
• Completes projects that are pro-active and focused on problem areas and high cost services to ensure maximum contractual reimbursement.
• Understands the reimbursement methods by contract and knowledge of PMMC for contract management reporting.
• Develops a strong relationship with insurance carriers in order to address multiple underpayments by a given payer.

Qualifications

• A minimum of five (5) years of collections or healthcare-related experience within a healthcare setting.
• A bachelor’s degree can substitute for the required work experience.

Preferred Qualifications

• Certified Patient Account Technician (CPAT) or Certified Revenue Cycle Specialist (CRCS).
• Demonstrated analytic skills.
• Demonstrated computer skills in spreadsheet database, word processing, PMMC and any other applications.
• Strong interpersonal skills, including the ability to handle difficult situation in a diplomatic manner.
• Ability to type a minimum of forty-five (45) words per minute.

Benefits

Onsite position. Monday through Friday, 8 hours per day.