MHS - Managed Care - Analyst_Senior Managed Care

The Senior Managed Care Analyst is responsible for evaluation, negotiation, monitoring and administration of contracts, as well as leadership specific to the Managed Care Analyst Team. Contracts may include hospital, retail, physician and Mosaic Life Care provided services. The Financial Analyst is also responsible for net revenue analysis, price negotiations and will monitor contract performance through periodic evaluation and audits.

Responsibilities

• Provides managed care expertise to the organization.
• Performs contract reviews and negotiations with managed care organizations specific to the contractual and financial terms.
• Evaluates reimbursement methodologies and payor policy to determine financial impact to the organization.
• Monitors financial performance of managed care plans to determine opportunity to improve overall reimbursement through changes in contract terms or improved internal/external processes.
• Provides analysis and research specific to managed care for new programs/service lines.
• Maintains, validates and models payment information for cost accounting system and monthly reporting.
• Works with PFS and Payment Validation to identify trends and opportunities for enhanced reimbursement.
• Maintain the estimated collection percentage on our expected reimbursement semi-annually in the cost accounting system.
• Provides in-service education, as needed, to caregivers in other departments.
• Investigate and resolve payor issues.
• Other duties as assigned

• Bachelor's Degree - Accounting, finance, or related field, from an accredited college or university or equivalent work experience - Required

• Prior experience and knowledge in the use of software packages such as Microsoft Excel, Word, Access, and Windows.
• 5 Years - Healthcare or related experience in financial analysis required.
• Fundamental knowledge of clinical/financial information system use.
• Ability to work with limited supervision.
• Enthusiasm and high level of job interest.
• Possess excellent analytical and problem solving skills.
• Possess computer abilities to relate well with all customers and peers.
• Demonstrates the ability to relate well with all customers and peers
• Knows and applies fundamental clinical and financial concepts necessary to analyze populations and provide a concise summary in an organized fashion.
• Ability to prioritize and organize to maximize quality, value and service.

• Upon Hire

• Travel to off-site locations may be required. - Required

Qualifications

Essential Technical/Motor Skills

Interpersonal Skills

Essential Physical Requirements

• Able to sit and view computer screen for up to three hours at a time.
• Ability to occasionally stand; walk; use hands to handle or feel; and reach with hands and arms.
• Able to frequently lift and/or move up to 25 pounds.
• Specific vision abilities include close vision, depth perception, and ability to adjust focus.

Essential Mental Abilities

• Able to work in often stressful environments.
• Able to prioritize and meet deadlines.
• Able to provide weekly updates on projects.
• Able to work in moderate noise level.
• Able to lead in a team environment.

Essential Sensory Requirements

Exposure to Hazards

Other Skills and Abilities

• Ability to assist with various projects on an as needed basis.
• Apply fundamental concepts to practical problems.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Possess strong technical and professional skills.
• Possess strong organizational and communication skills.
• Multi-task oriented.
• Ability to work as part of a team.