Managed Care Senior Analyst at AdventHealth

Date Posted: 1/23/2022


Job Snapshot

  • Job Schedule
  • Location:
    Maitland, FL
  • Date Posted:
  • Job ID:
  • Job Family
    Managed Care
  • Shift
    1 - Day

Job Description


Managed Care Senior Analyst | AdventHealth Corporate

Location Address: 2600 Lucien Way, Maitland, FL 32751

Top Reasons to Work at AdventHealth Corporate

  • Great benefits
  • Day 1 Health Insurance Coverage
  • Career growth and advancement potential

Work Hours/Shift:

  • Full-Time, Monday – Friday

You Will Be Responsible For:

  • Supports Managed Care leadership in contract negotiations through detailed financial modeling, comparative analysis, and benchmarking.
  • Evaluates and understands contractual language as it relates to reimbursement methodologies
  • Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and revenue codes
  • Demonstrates proficiency with various reimbursement methodologies including, Per Diem, DRG, fee schedules, and percent of charge
  • Demonstrates extensive knowledge of both commercial and governmental payers for modeling and analyzing contract proposals
  • Recommends contractual payment term changes that achieve net revenue targets developed by the Regional Managed Care Directors and Contract negotiators.
  • Develops and performs analytical and planning functions in support of Managed Care decision making
  • Leads in the development and review of the annual Managed Care Net Revenue budgets to support the annual AHS budget process.
  • Utilizes a variety of software applications and data sources to develop and produce the Managed Care Suite, DAA reports, other standard reporting, and adhoc reports         
  • Utilizes a variety of software applications and data sources to ensure contract compliance with Charge Neutralization requirements within payor agreements
  • Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance
  • Provides oversight and training in the development of the financial analysts within the department
  • Completes timely and accurate financial analyses related to Managed Care net revenue.
  • Demonstrates independent thinking and creativity in development of contract models, standard reports and ad hoc analyses
  • Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by Leadership
  • Changes and manages priorities to accomplish project deadlines and department goals
  • Maintains a high degree of accuracy while using large amounts of data
  • Prepares well-organized project-specific documentation, that includes at a minimum, analytic methods used, key decision points and caveats, with sufficient detail to support comprehension and replication.
  • Demonstrates strong project management and organizational skills by maintaining up-to-date project lists to assist in setting appropriate project priorities
  • Applies technical expertise in the development of models and decision support information
  • Assures the application of appropriate standards of data analysis and that all analytics are quality checked
  • Serves as process and content expert by demonstrating a thorough understanding of reimbursement methodologies and their impact on internal systems and other departments
  • Contributes to the overall completion of the work product in group project situations
  • Maintains and utilizes available resources to ensure work is completed accurately and timely

What You Will Need:

Education and Experience Required:

  • Bachelor’s degree in Finance, Economics, Mathematics, Accounting, Statistics or related field
  • At least five years of analytic experience with emphasis in healthcare and/or clinical application and health insurance finances
  • Technical experience in utilizing analytical software tools and applications
  • Experience working with healthcare, insurance or claims data
  • Healthcare information systems (PCON, Cerner, Soarian, Athena)
  • Data warehousing tools (Access, SQL Server, etc.)
  • Experience with statistical applications, Microsoft Visual Basic, and analytics interfaces such as QlikView or Tableau preferred

Knowledge and Skills Required:

  • Knowledge of common analytical methods such as modeling payer terms, comparing actual to expected reimbursement, and detailing reimbursement by service line
  • Intermediate level of proficiency in performing data and contract analytics; ability to effectively apply analytical and quantitative skills in reviewing payer reimbursement performance.
  • Ability to use knowledge and understanding of data, data systems, and contract management software applications, clinical and other information generated by numerous sources to identify opportunities to improve contract reimbursement performance
  • Working knowledge of healthcare or insurance accounting methods and reporting, standards development, utilization measurements, and financial modeling
  • Ability to conduct oneself professionally, maintain confidence, confidentiality and objectivity
  • Ability to relate operational and financial performance in the healthcare environment
  • Ability to learn quickly and work with minimal supervision
  • Ability to efficiently manage multiple work streams, clients and analyses
  • Proficiency with Microsoft Access, Excel, Power Point and Word
  • Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff
  • Must demonstrate an ability and willingness to learn and adapt to a constantly changing reimbursement environment

Job Summary:

The Senior Managed Care Analyst is responsible for analytic strategies focused on Managed Care Payer Contract Performance.  Areas of focus include modeling Payer Contract terms including Fixed, Percent of Charge, Fee Schedule and Value Based Methodologies.  The Senior Managed Care Analyst engages clients (health plans, leaders and providers) in reviewing reimbursement data including but not limited to financial performance, contract compliance, denial reviews, and prospective modeling of proposed contract terms.  The Senior Managed Care Analyst will provide analyses and strategic recommendations to maximize and optimize payer reimbursement in the aggregate as well as at key service line levels.  The Senior Managed Care Analyst will have expertise in Governmental (Medicare, Medicaid, Tricare) and Commercial payer reimbursement language and methodologies.  The Senior Managed Care Analyst works with Managed Care staff in all AHS Divisions, as well as payers in all markets.  Actively participates in outstanding customer service and maintain relationships with clients who include: AHS facility controllers, accountants and Managed Care Directors.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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