ESSENTIAL FUNCTIONS:
1.
Prepare analysis related to the financial and operational performance of health
care contracts, including the impact of regulatory rate or other changes and
identify the financial and/or operational performance of those agreements.
Recommends areas of improvement.
2.
Provides analysis for Medicaid and other Managed Care products such as HMO, PPOs
and POS products.
3.
Monitor and trend third party reimbursement including denial analysis.
4.
Create financial models as required to analyze data and report efficiently for
existing and new reports.
5.
Supports Management by providing information, locating data sources and
collecting data under tight time constraints.
6.
Identify and analyze utilization patterns driving health care costs and
recommend actions to impact financial performance.
7.
Reviews all shared risk claims, capitation, risk pool settlements, and various
reports submitted by the health plans. Submit shared risk discrepancy reports
within the time limits required by each individual health plan and in the format
requested by each individual health plan.
8.
Create various reports regarding payor reimbursement for Senior Leadership.
9.
Charged with providing recommendations to Revenue Cycle regarding changes in
utilization of those applications.
10.
Create queries to pull financial/claims data that will then be used to develop
analytical and statistical models to help customers make informed business
decisions.
11.
Identifies and communicates trends and/or potential issues to management team.
12.
Serves as the liaison between health plans and revenue cycle.
13.
Collaborates with Contracting/Credentialing Dept to optimize health payor
reimbursement outcomes
14.
Analyze health payor optimization within each market
15.
Create and schedule JOCs with each applicable health plan rep for each market
16.
Updates & Audits Clearwave system to ensure provider information is most current
17.
Extracts and queries data from multiple sources and systems and compile data in
the form of written and verbal reports and presentation.
The job holder must demonstrate current competencies for job position.
EDUCATION:
High school graduate or equivalent. Bachelor’s Degree in Finance or Healthcare
Administration preferred.
EXPERIENCE:
Must have a minimum of three years’ experience working in analytic or analyst
role in a healthcare environment with an in depth knowledge of physician
reimbursement. Experience in using relational databases, decision support
systems, analysis and modeling.
REQUIREMENTS:
Two or more years’ experience with Revenue Cycle Billing
KNOWLEDGE:
1.
Knowledge of the Payor Reimbursement process.
2.
Knowledge of computer systems.
3.
Knowledge of Health Plan Billing claim paperwork and timelines.
4.
Knowledge of Health Plan Billing timelines and regulations.
SKILLS:
1.
Skill in establishing good working relationships with internal and external
customers.
2.
Skill in organizing daily work assignments for various tasks.
3.
Skill in managing multiple work assignments and set priorities.
4.
Skill in meeting demanding deadlines.
ABILITIES:
1.
Ability to establish good working relationships with internal and external
customers.
2.
Ability to communicate effectively with staff, leadership, health plan
representatives, other depts.
3.
Ability to be organized and efficient in daily work activities/projects.
4.
Ability to exercise independent judgment and decision-making abilities.
ENVIRONMENTAL/WORKING CONDITIONS:
Normal office environment.
PHYSICAL/MENTAL DEMANDS:
Requires sitting and standing associated with a normal office environment. Some
bending and stretching required. Manual dexterity using a calculator and
computer keyboard.
ORGANIZATIONAL REQUIREMENTS:
1.
CORE Creed must be read and signed.
2.
OSHA Requirements and training to include:
Safety Training.
This description is intended to provide only basic guidelines for meeting job
requirements. Responsibilities, knowledge, skills, abilities and working
conditions may change as needs evolve.