Senior Managed Care Analyst - Full Time

Ranked #1 for Safety, Quality and Patient Satisfaction, Jupiter Medical Center is the leading destination for world-class health care in Palm Beach County and the greater Treasure Coast.

Outstanding physicians, state-of-the-art facilities, innovative techniques and a commitment to serving the community enables Jupiter Medical Center to meet a broad range of patient needs. Jupiter Medical Center is the only hospital in Palm Beach, Martin, St. Lucie and Indian River counties to receive a 4-star quality and safety rating from the Centers for Medicare & Medicaid Services (CMS).

Education

• Bachelors Degree in Accounting or Finance required.
• Masters Degree in relevant field preferred.

Experience / Qualifications

• Minimum five years of Payer Contracting or Revenue Cycle experience that includes payer contract modeling, familiarity with fee schedules and charge masters, pricing transparency, billing, prior authorization, and denial processes.
• Knowledge of Medicare Allowable rate calculations for: DRGs for inpatient hospital claims,   APC rates for outpatient hospital claims, drug, ASC and physician payment rates for global, technical and professional rates by modifiers.
• Knowledge of Government and Third Party Payor Regulations and Standards.
• Epic experience preferred.
• Must be familiar with medical terminology, coding processes, clinical documentation and governmental and non-governmental reimbursement methodologies.
• Attention to detail, high degree of accuracy, and ability to multitask within a fast paced, results-orientated environment required.
• Mathematical ability and analytical skills required.
• Computer proficiency required, particularly Microsoft Office and Excel.

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.
• Performs other duties as assigned.

Team Member Competencies

Establishing Relationships

Builds effective networks, working relationships, and alliances to collaborate effectively within department and organization.  Can relate to all kinds of people regardless of background; find topics and common interests that can be used to build rapport with others.

Peer Support

Provides guidance and feedback to help others strengthen knowledge/skills needed to accomplish tasks, solve problems, and perform effectively within the team. 

Inspiring and Motivating Others

Fosters commitment and cohesiveness by facilitating cooperation and working as a team within the organization toward goal accomplishments.  Work well with others, build consensus, and ensure cooperation to complete tasks and positive workflow. 

Demonstrating Emotional Intelligence

Exercises self-leadership, self-awareness, and self-regulation; manages emotions so that they are expressed appropriately; leads others by showcasing adaptability, empathy, and social skills.

Acting with Integrity

Interacts with others in a way that is seen as direct and truthful; ensures confidence in individual and organizational motives and representations.  Acts in a way that is consistent with personal and organizational values by keeping confidence, promises, and commitments.  Clearly states goals and beliefs; informs people of their true intentions, does what they say they will do; follows through on commitments.

Being a Champion for Change and Innovation

Supports people in their efforts to try new things.  Things creatively, generates novel and valuable ideas and uses these ideas to develop new or improved processes. Accepts new ways of doing things and adapts to change.

Communicating Effectively

Speaks and writes clearly, conveys information in a concise, organized, and logical manner.  Is adept at tailoring the message to fit the interests and needs of the audience.  Listens attentively and exercises tact, discretion, and diplomacy when interacting with members of the department and organization.

Promoting Diversity and Inclusion

Treats all people with dignity and respect.  Demonstrates an open-minded approach to understanding people regardless of their gender, age, race, national origin, religion, ethnicity, disability status, or other characteristics.  Challenges bias and intolerance.  Develops all-inclusive groups in the realms of social interaction and communication.  Shows respect for the beliefs of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds.

Physical Requirements

Requires sitting for long periods of time, also stooping, bending, standing, and stretching. May require lifting up to 20 lbs. Must have manual dexterity for typing and computer data entry. Able to work under a stressful environment, work independently, capable of making sound decisions, be detail oriented, alert, and self-motivated. Ability to push/pull up to 40lbs., carry and lift up to 20lbs. Travel as needed.

Threshold Requirements

• These threshold requirements are required and completed yearly basis.
  • 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).

This is not necessarily an extensive list of all responsibilities, skills, duties, requirements, or working conditions associates with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or require that other or different tasks be performed when circumstances change. I have reviewed these job requirements and verify that I can perform all essential functions of this position.