Job details
Job type full-time
Benefits pulled from the full job description
401(k) dental insurance health insurance life insurance paid time off vision insurance
Not provided by employer
Full job description
Must apply using this link: corporate application
Senior managed care analyst - remote
We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for careWe build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier livesThrough collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.
The senior managed care analyst, crc ct region, will analyze and synthesize financial and operational data to inform and accelerate the understanding of complex financial terms/ramifications of new and renegotiated contracts, as well as other strategic decisions to those who may not fully understand (hospital ceos, medical group leadership, etc.) and to model different contracting and other strategic prototypes which will position us for financial success for each potential agreement or serviceAdditionally, they will need to be able to showcase the core financial benefits/challenges of our business decisions both in terms of financial modeling, comparative analysis and creation of standardized financial presentations.
The analysis results will be presented utilizing power point, excel, business analytics (bi) platforms to assist the organization in understanding the valuation based framework we are working within for the myriad of contracting models (ffs, capitation, per diem, drg, ap-drg) and types of agreements (plan to hospital, hospital to hospital, risk sharing agreements, ancillary agreements, loas and transfer agreements) for multiple different clients (health plans, ppos, tpas, risk bearing hospitals/ids, risk bearing ipas/medical groups,) and downstream providers on our division of financial responsibilities (dofrs) such as snf, hh, pharmacology, recuperative care and transportation.
The successful candidate must be well organized, self-directed, attention to detail driven, be forward thinking, have excellent communication skills, be calm under pressure, open to challenge, suggestions and be able to successfully work with different communication styles and understand different points of viewThey must have the courage to differ with other points of view and to accept constructive feedbackThe successful candidate must be proficient in business applications such as: excel, power point, business analytics (bi), and other analytic toolsIdeally, they will have earned a bachelors in finance, accounting or business, have hospital financial analysis experience, be microsoft certified in dynamics 365 customer service functional (or the predecessor certification) services which is a customer service based solution to drive actionable insights to make business decisions.
Job responsibilities/duties
Understands and abides by hipaa privacy and security laws and regulations
Observes all applicable federal, state and local laws and regulations
Must be extremely organized and detailed oriented
Must have a dedicated home-based location in which to focus and complete work assignments with limited interruptions
Ability to multi-task in a fast-paced environment and handle multiple priorities sometimes simultaneously
Must be able to work under pressure to meet deadlines and turnaround time requirements
Must have strong reasoning and problem-solving abilities and planning skills
Familiarizes oneself and learns new technologies and systems as needed
Attends seminars/workshops/online learning as directed
Continually strives to suggest improvements that will provide new or better insight into the review process
Must be able to work within a remote team structure in a supportive role, as well as, independently while staying within scope of responsibilities and of duties
Knowledge of payor reimbursement structures for at-risk services, ancillary services, familiarity with hospital cost accounting, hospital services, in-depth knowledge of state managed care, and multiple state insurance regulations
Solid understanding of government payor reimbursement methodologies, contract terms and provisions, commercial reimbursement methodologies, fee schedules, bundled payments, capitation, p4p program, medical coding including medicaid, medicare and state worker’s compensation benefit plans as well as development of various complex types of modeling and analysis of a myriad of data to make meaningful insight
Extracts data from core system/data warehouse or other systems and utilizes excel, access, contract management system and/or other systems to build complex interactive reimbursement models/analytics
Through routine or special audits, compares actual payments vsExpected payments to identify payments that do not meet contractual terms.
Tracks payer compliance with contract provisions and works with cbo and/or outside vendors to correct payer non-compliance.
Compares payer performance against other similar payers and government payers
Reviews all data to ensure accuracy, understands the use and importance of information collected and highlight significant findings
Ability to present business presentations as well as develop concise business communications and correspondence
Ability to effectively present information in a microsoft teams environment and respond to questions from managers, employees, clients, customers and the general public
Provide accurate and timely analytics for management and senior leadership that is informative
Maintain grids as needed by the department
Provides analysis on industry trends and applicable government regulations with the understanding of the implication of how this will impact the hospitals
Researches managed care and governmental payer policies, calculates the impact of payer policy changes, provides recommendations to management.
Stays current on managed care and government payer policies and regulations while providing recommendations when needed.
Qualifications
Minimum education: bachelor’s degree in a finance, or commensurate experience and education (e.gAa degree in finance and 5 years of hospital financial analytics experience) required.
Minimum experience: a minimum of three (3) years of hospital finance and/or contracting experience for multi-hospital system or integrated delivery systemExperienced and comfortable with development, use and challenge of reimbursement analysis and modeling .excellent written, verbal communication and computer skillsKnowledge of the payor industry and comfortable presenting to senior leadership as well as communicating with payorsExceptional skills using microsoft office excel (including advanced spreadsheet, formula manipulation and modeling)Strong ms word and ms powerpoint skills (ms access/project management skills a plus) and sharepoint and teams skillsDemonstrated attention to detail, project management and implementation of processesPrior remote employment, with a demonstrated ability to self-motive and direct with limited supervisionAbility to research competitive pricing of hospital, ancillary, medical group/ipa and health plan reimbursementUnderstanding of alternate payment methodologies.
ReqCertification/licensure: none.
Employee value proposition
Prospect medical holdings, inc., is guided by a diverse and highly experienced leadership coreThis group maintains the vision that has made prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued effortsAs a member of our highly effective team of professionals, benefit eligible positions will receive:
Company 401k
Medical, dental, vision insurance
Paid time-off
Life insurance
Prospect medical systems has a zero-tolerance policy regarding the use of drugs and alcoholOur company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harmFor this reason, we require applicants to pass a screening for drug use as a condition of employmentThis includes: alcohol, marijuana, cocaine, opiates and methamphetamines.
Apply Now
To apply for this role: corporate application or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!
We are an equal opportunity/ affirmative action employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristicsIf you need special accommodation for the application process, please contact human resources.
Eeoc is the law: https://www.eeoc.gov/
Location: eastern connecticut health network · financial operations
Schedule: full-time, day, 37.5
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Posted 30+ days ago
