Managed Care Analyst Patient Financial Services

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsible for contract management, project management and associated reporting to support internal/external customers andassure compliance with state, federal and other regulatory agency requirements

• Maintains an understanding of the key elements of a payer contracts (commercial, Medicare advantage, Medicaid HMO), including reimbursement requirements.
• Reviews contracts and makes recommendations to ensure standardization and consistency in payer agreements.
• Performs audits to validate payer compliance with contracts by using various standard reports, data integrity testing and claimreconciliation payment data. Identifies opportunities and makes recommendations to renegotiate contacts, in order to maximizehospital reimbursement levels.
• Performs quality control measures on contract processes, including system setup, claim adjudication and payment reconciliation.
• Drafts contract documents and letters to payors.
• Models DRG reimbursement, CPT or UB Code based reimbursement and simple and complex contracts.
• Updates all necessary elements of the reimbursement summary.
• Analyzes and researches account(s) for contract interpretation errors or incorrect payments and pursues additional payment if necessary.
• Researches payor medical policies for coverage issues or for contract compliance.
• Organizes and provides data support for all payor issues in anticipation of a payor meetings.
• Leads payor meetings and ensures that all necessary documents/analysis are provided by deadlines.
• Researches new types of insurance product offerings through a variety of sources.
• Obtains and analyzes the various filings by insurance companies to the department of insurance.
• Prepares monthly variance reports.
• Reviews monthly contractuals to determine cause of any variances.
• Prepares the budget/forecast model for contractuals.
• Responsible for the Decision Support System generation and analysis of the following:
  - Detailed Patient Listings - Case Mix / Payor Mix - Expected vs Actual Payments - Data for use in and completion of Project Analysis - Budget Modeling - Net Revenue Modeling -  Models all elements of contract for Revenue Cycle Processing 
• Responsible for maintaining a working knowledge of the following:
  - Collections and posting process. -  Interaction between all aspects of the revenue cycle. - Interaction of the chargemaster, coding and expected reimbursement. - Takes full accountability for all work assigned including following up with others in the process. - Prepares 100% accurate analysis for any assignment and presents in executive ready format.
• Responsible for the coordination and completion of Revenue Cycle projects, including, but not limited to, complianceissues, charge discrepancies, data integrity, and new service monitoring. Serves as the PFS department representative on projects that involve multiple department participation

• Associate's degree in Business Administration or relatedfieldand five years of experience in a hospital or medical
  insurance business office setting; Bachelor’s degree preferred. An equivalent combination of educationand/orexperience may be considered.
• Experience working with managed care contracts, including contract negotiation and analysis preferred.
• Thorough knowledge of PC based applications with
  intermediate experience in MS Word and Excel, including charts and graphs.
• Knowledge of Google Suite is preferred.
• Thorough knowledge and intermediate experience in database applications with a working knowledge of information systems operations. 
• Electronic Medical Record (EMR) experience preferred; Cernerstrongly preferred
• Broad healthcare knowledge in all aspects of admitting, billingand collection.
• Experience in training and development activities.
• Excellent multi-tasking, analytical, organizational andproblem-solving skills.
• Excellent interpersonal skills and the ability to effectivelycommunicate verbally and in writing providing excellent customer service.
• Must be able to adapt to change of duties quickly and smoothly