Managed Care Payment Analyst, Full-Time
for section headings. Use - for any list of duties/requirements/benefits, and
for prose.
We need to preserve all substantive information, not invent or summarize away detail. So we need to extract details.
Let's parse the posting:
Job Summary: The Managed Care Payment Analyst will audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments. Analyst will Identify issues with contract management projections and make recommendations to Manger of Payer Relations. In addition, Analyst will review fatal technical denials and pursue additional payment under other negotiated terms, when possible. Analyst will work independently and must be able to interpret, understand, and effectively debate contract terms with payers to resolve payment disputes. The Analyst will independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to the Manager of Payer Relations. Analyst must have strong verbal and communication skills to effectively communicate with internal and external parties, including independently filing reconsiderations, payment appeals, initiating calls, and conducting meetings with payers to obtain accurate payment. Analyst must meet performance goals set by the Director and the Manager of Payer Relations to achieve organizational goals. The Analyst must maintain a thorough knowledge of all managed care agreements and must have a thorough understanding of managed care payment methodologies, including an understanding of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, and other rate methodologies. An expert knowledge of Microsoft Office products including Excel, Access, and Word is required. The Payment Analyst will participate in special projects, provide reporting, and will assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts are administered with maximum reimbursement.
Education: Required: Associate degree or comparable experience in a relevant role such as a senior medical high dollar hospital reimbursement analyst Preferred: Bachelor's Degree in related field with related experience Experience: Required: Superior analytical skills and attention to detail a must. Preferred: Minimum three years of experience in managed care & variance follow-up in Epic Position Requirement(s): License/Certification/Registration Required: None Preferred: Department Position Summary: (duplicate of job summary) Erlanger Baroness Hospital Chattanooga, TNManaged Care Payment Analyst, Full-Time Standard Hours Regular
We need to avoid duplication. So we will combine unique info.
Let's structure:
About the role: maybe a brief prose summarizing role (job summary). Could be a
with the job summary sentences.
Responsibilities: list of duties: audit managed care claims payments, calculate reimbursement based on contract terms using contract management system, reports, documentation to identify underpayments; identify issues with contract management projections and make recommendations to Manager of Payer Relations; review fatal technical denials and pursue additional payment under other negotiated terms when possible; work independently, interpret, understand, debate contract terms with payers to resolve payment disputes; independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to Manager of Payer Relations; strong verbal and communication skills to effectively communicate with internal and external parties, including filing reconsiderations, payment appeals, initiating calls, conducting meetings with payers to obtain accurate payment; meet performance goals set by Director and Manager of Payer Relations to achieve organizational goals; maintain thorough knowledge of all managed care agreements; thorough understanding of managed care payment methodologies (MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, other rate methodologies); expert knowledge of Microsoft Office products including Excel, Access, Word; participate in special projects, provide reporting, assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts administered with maximum reimbursement.
Requirements: maybe education and experience? The posting splits Education and Experience. Could combine into Requirements section. But we also have Qualifications and Skills sections. We need to decide mapping.
Typically: About the role (summary), Responsibilities (duties), Requirements (education/experience), Qualifications (maybe preferred?), Skills (specific skills). However we must only include sections if there is real specific content. We have content for Education, Experience, Skills (Microsoft Office, analytical skills, communication). We also have Preferred qualifications (Bachelor's degree, 3 years experience in managed care & variance follow-up in Epic). Also Required: Associate degree or comparable experience; Superior analytical skills and attention to detail a must.
We could make:
- About the role: job summary paragraph.
- Responsibilities: bullet list of duties (as above).
- Requirements: Education and Experience (required).
- Qualifications: Preferred qualifications (Bachelor's degree, 3 years experience in managed care & variance follow-up in Epic).
- Skills: Specific skills (analytical skills, attention to detail, verbal/communication skills, knowledge of payment methodologies, MS-DRG etc., expert knowledge of Microsoft Office).
- Schedule: Full-Time Standard Hours Regular.
We need to avoid repeating content. Ensure we don't duplicate.
Let's extract each piece.
Job Summary (About the role) text: "The Managed Care Payment Analyst will audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments. Analyst will Identify issues with contract management projections and make recommendations to Manger of Payer Relations. In addition, Analyst will review fatal technical denials and pursue additional payment under other negotiated terms, when possible. Analyst will work independently and must be able to interpret, understand, and effectively debate contract terms with payers to resolve payment disputes. The Analyst will independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to the Manager of Payer Relations. Analyst must have strong verbal and communication skills to effectively communicate with internal and external parties, including independently filing reconsiderations, payment appeals, initiating calls, and conducting meetings with payers to obtain accurate payment. Analyst must meet performance goals set by the Director and the Manager of Payer Relations to achieve organizational goals. The Analyst must maintain a thorough knowledge of all managed care agreements and must have a thorough understanding of managed care payment methodologies, including an understanding of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, and other rate methodologies. An expert knowledge of Microsoft Office products including Excel, Access, and Word is required. The Payment Analyst will participate in special projects, provide reporting, and will assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts are administered with maximum reimbursement."
That is quite long; could be used as About the role.
Responsibilities: Could be a subset focusing on duties. But the job summary already includes many duties. To avoid duplication, we could split: About the role = brief overview (maybe first sentence). Responsibilities = bullet list of duties. However we must preserve all substantive information; we can't omit details. If we put all details in About the role, we could leave Responsibilities empty or not include it. But we need to include sections only when posting has real specific content. If we put all content in About the role, we could still include Responsibilities but would need to avoid duplication. Better to split logically: About the role = brief description (maybe first two sentences). Responsibilities = bullet list of duties (the rest). Qualifications/Skills/Education/Experience separate.
Let's try to extract distinct chunks:
Core role description: "The Managed Care Payment Analyst will audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments."
That's a good overview.
Responsibilities bullet list:
- Identify issues with contract management projections and make recommendations to Manager of Payer Relations.
- Review fatal technical denials and pursue additional payment under other negotiated terms, when possible.
- Work independently and must be able to interpret, understand, and effectively debate contract terms with payers to resolve payment disputes.
- Independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to the Manager of Payer Relations.
- Strong verbal and communication skills to effectively communicate with internal and external parties, including independently filing reconsiderations, payment appeals, initiating calls, and conducting meetings with payers to obtain accurate payment.
- Meet performance goals set by the Director and the Manager of Payer Relations to achieve organizational goals.
- Maintain a thorough knowledge of all managed care agreements.
- Maintain a thorough understanding of managed care payment methodologies, including an understanding of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, and other rate methodologies.
- Expert knowledge of Microsoft Office products including Excel, Access, and Word is required.
- Participate in special projects, provide reporting, and assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts are administered with maximum reimbursement.
Note: Some of these are more like skills/knowledge. But we can keep them in Responsibilities.
Education/Experience (Requirements):
- Required: Associate degree or comparable experience in a relevant role such as a senior medical high dollar hospital reimbursement analyst.
- Preferred: Bachelor's Degree in related field with related experience.
- Required: Superior analytical skills and attention to detail a must.
- Preferred: Minimum three years of experience in managed care & variance follow-up in Epic.
- License/Certification/Registration Required: None.
We could separate Required vs Preferred into Requirements and Qualifications.
Skills: maybe the specific technical skills: knowledge of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, other rate methodologies; expert knowledge of Microsoft Office Excel, Access, Word; strong verbal and communication skills; analytical skills; attention to detail.
But we already listed analytical skills and attention to detail in Requirements. Could move them to Skills.
Let's decide:
- About the role: overview sentence.
- Responsibilities: bullet list of duties (excluding education/experience/skills? but we can include some overlapping).
- Requirements: Education and Experience (required).
- Qualifications: Preferred education/experience.
- Skills: Specific skills (analytical, attention to detail, communication, knowledge of payment methodologies, Microsoft Office).
- Schedule: Full-Time Standard Hours Regular.
We must ensure we don't repeat same bullet across sections. Let's try to allocate.
First, extract all unique statements:
1. Audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments. (Overview)
2. Identify issues with contract management projections and make recommendations to Manager of Payer Relations.
3. Review fatal technical denials and pursue additional payment under other negotiated terms, when possible.
4.
for prose. We need to preserve all substantive information, not invent or summarize away detail. So we need to extract details. Let's parse the posting: Job Summary: The Managed Care Payment Analyst will audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments. Analyst will Identify issues with contract management projections and make recommendations to Manger of Payer Relations. In addition, Analyst will review fatal technical denials and pursue additional payment under other negotiated terms, when possible. Analyst will work independently and must be able to interpret, understand, and effectively debate contract terms with payers to resolve payment disputes. The Analyst will independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to the Manager of Payer Relations. Analyst must have strong verbal and communication skills to effectively communicate with internal and external parties, including independently filing reconsiderations, payment appeals, initiating calls, and conducting meetings with payers to obtain accurate payment. Analyst must meet performance goals set by the Director and the Manager of Payer Relations to achieve organizational goals. The Analyst must maintain a thorough knowledge of all managed care agreements and must have a thorough understanding of managed care payment methodologies, including an understanding of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, and other rate methodologies. An expert knowledge of Microsoft Office products including Excel, Access, and Word is required. The Payment Analyst will participate in special projects, provide reporting, and will assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts are administered with maximum reimbursement. Education: Required: Associate degree or comparable experience in a relevant role such as a senior medical high dollar hospital reimbursement analyst Preferred: Bachelor's Degree in related field with related experience Experience: Required: Superior analytical skills and attention to detail a must. Preferred: Minimum three years of experience in managed care & variance follow-up in Epic Position Requirement(s): License/Certification/Registration Required: None Preferred: Department Position Summary: (duplicate of job summary) Erlanger Baroness Hospital Chattanooga, TNManaged Care Payment Analyst, Full-Time Standard Hours Regular We need to avoid duplication. So we will combine unique info. Let's structure: About the role: maybe a brief prose summarizing role (job summary). Could be a
with the job summary sentences. Responsibilities: list of duties: audit managed care claims payments, calculate reimbursement based on contract terms using contract management system, reports, documentation to identify underpayments; identify issues with contract management projections and make recommendations to Manager of Payer Relations; review fatal technical denials and pursue additional payment under other negotiated terms when possible; work independently, interpret, understand, debate contract terms with payers to resolve payment disputes; independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to Manager of Payer Relations; strong verbal and communication skills to effectively communicate with internal and external parties, including filing reconsiderations, payment appeals, initiating calls, conducting meetings with payers to obtain accurate payment; meet performance goals set by Director and Manager of Payer Relations to achieve organizational goals; maintain thorough knowledge of all managed care agreements; thorough understanding of managed care payment methodologies (MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, other rate methodologies); expert knowledge of Microsoft Office products including Excel, Access, Word; participate in special projects, provide reporting, assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts administered with maximum reimbursement. Requirements: maybe education and experience? The posting splits Education and Experience. Could combine into Requirements section. But we also have Qualifications and Skills sections. We need to decide mapping. Typically: About the role (summary), Responsibilities (duties), Requirements (education/experience), Qualifications (maybe preferred?), Skills (specific skills). However we must only include sections if there is real specific content. We have content for Education, Experience, Skills (Microsoft Office, analytical skills, communication). We also have Preferred qualifications (Bachelor's degree, 3 years experience in managed care & variance follow-up in Epic). Also Required: Associate degree or comparable experience; Superior analytical skills and attention to detail a must. We could make: - About the role: job summary paragraph. - Responsibilities: bullet list of duties (as above). - Requirements: Education and Experience (required). - Qualifications: Preferred qualifications (Bachelor's degree, 3 years experience in managed care & variance follow-up in Epic). - Skills: Specific skills (analytical skills, attention to detail, verbal/communication skills, knowledge of payment methodologies, MS-DRG etc., expert knowledge of Microsoft Office). - Schedule: Full-Time Standard Hours Regular. We need to avoid repeating content. Ensure we don't duplicate. Let's extract each piece. Job Summary (About the role) text: "The Managed Care Payment Analyst will audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments. Analyst will Identify issues with contract management projections and make recommendations to Manger of Payer Relations. In addition, Analyst will review fatal technical denials and pursue additional payment under other negotiated terms, when possible. Analyst will work independently and must be able to interpret, understand, and effectively debate contract terms with payers to resolve payment disputes. The Analyst will independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to the Manager of Payer Relations. Analyst must have strong verbal and communication skills to effectively communicate with internal and external parties, including independently filing reconsiderations, payment appeals, initiating calls, and conducting meetings with payers to obtain accurate payment. Analyst must meet performance goals set by the Director and the Manager of Payer Relations to achieve organizational goals. The Analyst must maintain a thorough knowledge of all managed care agreements and must have a thorough understanding of managed care payment methodologies, including an understanding of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, and other rate methodologies. An expert knowledge of Microsoft Office products including Excel, Access, and Word is required. The Payment Analyst will participate in special projects, provide reporting, and will assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts are administered with maximum reimbursement." That is quite long; could be used as About the role. Responsibilities: Could be a subset focusing on duties. But the job summary already includes many duties. To avoid duplication, we could split: About the role = brief overview (maybe first sentence). Responsibilities = bullet list of duties. However we must preserve all substantive information; we can't omit details. If we put all details in About the role, we could leave Responsibilities empty or not include it. But we need to include sections only when posting has real specific content. If we put all content in About the role, we could still include Responsibilities but would need to avoid duplication. Better to split logically: About the role = brief description (maybe first two sentences). Responsibilities = bullet list of duties (the rest). Qualifications/Skills/Education/Experience separate. Let's try to extract distinct chunks: Core role description: "The Managed Care Payment Analyst will audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments." That's a good overview. Responsibilities bullet list: - Identify issues with contract management projections and make recommendations to Manager of Payer Relations. - Review fatal technical denials and pursue additional payment under other negotiated terms, when possible. - Work independently and must be able to interpret, understand, and effectively debate contract terms with payers to resolve payment disputes. - Independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to the Manager of Payer Relations. - Strong verbal and communication skills to effectively communicate with internal and external parties, including independently filing reconsiderations, payment appeals, initiating calls, and conducting meetings with payers to obtain accurate payment. - Meet performance goals set by the Director and the Manager of Payer Relations to achieve organizational goals. - Maintain a thorough knowledge of all managed care agreements. - Maintain a thorough understanding of managed care payment methodologies, including an understanding of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, and other rate methodologies. - Expert knowledge of Microsoft Office products including Excel, Access, and Word is required. - Participate in special projects, provide reporting, and assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts are administered with maximum reimbursement. Note: Some of these are more like skills/knowledge. But we can keep them in Responsibilities. Education/Experience (Requirements): - Required: Associate degree or comparable experience in a relevant role such as a senior medical high dollar hospital reimbursement analyst. - Preferred: Bachelor's Degree in related field with related experience. - Required: Superior analytical skills and attention to detail a must. - Preferred: Minimum three years of experience in managed care & variance follow-up in Epic. - License/Certification/Registration Required: None. We could separate Required vs Preferred into Requirements and Qualifications. Skills: maybe the specific technical skills: knowledge of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, other rate methodologies; expert knowledge of Microsoft Office Excel, Access, Word; strong verbal and communication skills; analytical skills; attention to detail. But we already listed analytical skills and attention to detail in Requirements. Could move them to Skills. Let's decide: - About the role: overview sentence. - Responsibilities: bullet list of duties (excluding education/experience/skills? but we can include some overlapping). - Requirements: Education and Experience (required). - Qualifications: Preferred education/experience. - Skills: Specific skills (analytical, attention to detail, communication, knowledge of payment methodologies, Microsoft Office). - Schedule: Full-Time Standard Hours Regular. We must ensure we don't repeat same bullet across sections. Let's try to allocate. First, extract all unique statements: 1. Audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments. (Overview) 2. Identify issues with contract management projections and make recommendations to Manager of Payer Relations. 3. Review fatal technical denials and pursue additional payment under other negotiated terms, when possible. 4.