Senior Managed Care Analyst - Full Time

Position Summary

The Senior Managed Care Analyst is responsible for providing support to the Managed Care Department. Works closely with the Director of Managed Care to assist with reviewing managed care contracts and payer amendments. Identifies and escalates complex, complicated, or challenging patient accounts to the Director of Managed Care to ensure accounts are progressing effectively. Tracks and models payer performance metrics such as realization rates and variances. Evaluates detailed fee schedule data to compare to market trends utilizing pricing transparency tools. Partners with the revenue cycle team to evaluate denials, audits, and appeals (post-payment) trends for both governmental and non-governmental insurers. Maintains contract summaries, spreadsheets, and documentation of trends to ensure conversations are taking place with payers to discuss underperformance or violation of contract terms. Assists with correspondence directly between Jupiter Medical Center and the payers at the direction of the Director of Managed Care and the CFO. Collaborate with finance, billing, and revenue cycle teams. Complete data pulls and reporting from Epic and other billing systems. Maintains schedule of all Payor agreements with amendment descriptions to ensure the Director of Managed Care is notified of contract renewals timely to initiate strategy and negotiation conversations. Participate in monthly payor relations meetings to resolve escalated issues. Assists with creating payor presentations and review items for monthly meetings. Research governmental and non-governmental payor regulations and policies. Maintain positive working relationship with hospital departments. Knowledge of Medicare and Medicaid regulations, Compliance guidelines, ICD-10 and CPT/HCPCS coding.

Team Member Competencies

• Establishing Relationships
• Peer Support
• Inspiring and Motivating Others
• Demonstrating Emotional Intelligence
• Acting with Integrity
• Championing for Change and Innovation
• Communicating Effectively
• Promoting Diversity and Inclusion

Physical Requirements

• Sitting for long periods of time
• Stooping, bending, standing, and stretching
• Lifting up to 20 lbs.
• Carrying and lifting up to 20 lbs.
• Pushing/pulling up to 40 lbs.

Threshold Requirements

• Annual Joint Commission mandatory education requirements
• In-service and health requirements including attendance at new employee orientation
• TB/PPD Surveillance Program
• Maintenance of required professional licensing and/or certification(s)