MANAGED CARE ANALYST-HYBRID

Job Overview:

Performs analysis and rate modeling of managed care contracts in support of negotiations, re-negotiations and renewals. Analyzes rate proposals and develops strategies to increase revenue. Supports data driven decision making by formulating recommendations based upon data, trend analysis, financial and operational modeling and strategic market research. Performs a wide variety of duties including working collaboratively with internal stakeholders to drive key managed care initiatives and programs. Collaborates with Managed Care team, and internal stakeholders to develop rate structure proposals for payer negotiations. Interprets managed care contracts regarding contract and reimbursement terms, conditions, policies, guidelines and regulations, and keeps them current and accurate in various systems as assigned. Loads and ensures that managed care contracts rates and fee schedules are entered accurately in internal systems, including Epic. Updates contract management system in a timely manner with fee schedules and updated payment rates to ensure contracts rate remain current. Quality checks all contract builds in modeling system to validate contract build accuracy aligns with contractual agreement. Coordinates with revenue cycle and other financial staff to develop data sets for modeling. Works with revenue cycle staff to incorporate annual rate changes to the charge description master (CDM) into payer contract modeling and contract management, and calculates CDM impact for required payer notifications. Reviews and interprets managed care contracts regarding contract and reimbursement terms, conditions, policies, guidelines and regulations, and keeps them current and accurate in various systems. Validates the quality and accuracy of underlying data used for analysis and financial reporting. Works under the guidance of Manager, Managed Care Analytics or designee and within broad guidelines and technical standards. Follows-up with the payer as appropriate to obtain additional reimbursement information. Leads ongoing maintenance and auditing of contract management rate calculations. Works with Managed Care team to identify trends, and to review, and research variances. Communicates effectively with Managed Care team, payer representatives, and other internal and external stakeholders. Makes recommendations on contracting rates for new agreements and or renegotiated agreements based on existing rate information. Ensures all Protected Health Information is always kept in a secure location. Completes other projects as assigned.
Job Requirements:

Bachelor's Degree in Finance
business analytics, economics, computer science, biostatistics, health care administration, business administration, public health, finance, accounting, engineering, informatics, related field
EPIC Contract Modeling (or equivalent)
Equivalent experience accepted in lieu of degree
Excel and Power Point proficiency, familiar with SQL and Data visualization technology
3-4 years experience Professional Healthcare Managed Care Analytics

Job Responsibilities:

Performs analysis and rate modeling of managed care contracts in support of negotiations, re-negotiations and renewals. Analyzes rate proposals and develops strategies to increase revenue. Communicates effectively with Managed Care team, payer representatives, and other internal and external stakeholders.
Collaborates with Managed Care team, and internal stakeholders to develop rate structure proposals for payer negotiations. Interprets managed care contracts regarding contract and reimbursement terms, conditions, policies, guidelines and regulations, and keeps them current and accurate in various systems as assigned.
Loads and ensures that managed care contracts rates and fee schedules are entered accurately in internal systems.
Validates the quality and accuracy of underlying data used for analysis and financial reporting. Works under the guidance of Manager, Managed Care Analytics or designee and within broad guidelines and technical standards.
Ensures all Protected Health Information is always kept in a secure location.
Completes other projects as assigned.

Other Job-Related Information:

Working Conditions:

Climbing - Rarely
Concentrating - Consistently
Continuous Learning - Frequently
Hearing: Conversation - Frequently
Interpersonal Communication - Frequently
Kneeling - Rarely
Lifting <10 Lbs - Rarely
Lifting 50+ Lbs - Rarely
Lifting 11-50 Lbs - Rarely
Pulling - Rarely
Pushing - Rarely
Reaching - Consistently
Reading - Consistently
Sitting - Frequently
Standing - Consistently
Stooping - Rarely
Thinking/Reasoning - Consistently
Use of Hands - Frequently
Color Vision - Frequently
Walking - Frequently
TriHealth SERVE Standards and ALWAYS Behaviors
At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:

Serve: ALWAYS...
* Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
* Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
* Refrain from using cell phones for personal reasons in public spaces or patient care areas
Excel: ALWAYS...
* Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
* Offer patients and guests priority when waiting (lines, elevators)
* Work on improving quality, safety, and service
Respect: ALWAYS...
* Respect cultural and spiritual differences and honor individual preferences.
* Respect everyone's opinion and contribution, regardless of title/role.
* Speak positively about my team members and other departments in front of patients and guests.
Value: ALWAYS...
* Value the time of others by striving to be on time, prepared and actively participating.
* Pick up trash, ensuring the physical environment is clean and safe.
* Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Engage: ALWAYS...
* Acknowledge wins and frequently thank team members and others for contributions.
* Show courtesy and compassion with customers, team members and the community