Works with Managed Care Analyst Sr to oversee the balancing, reconciling, and resolution of errors for the daily 835 and 837 files, charges, payments, adjustments and contractuals to the patient accounts receivable system. Provides training, guidance, and support with the use of the managed care contracting system by Patient Financial Services (PFS) and other Revenue Cycle team members through education and daily communication. Oversees the Master Tables as assigned and collaborates with the Managed Care team to implement process improvements. Provides guidance and support for other system maintenance functions as required for data integrity of the contract modeling software. Develops reports/report views and explains and interprets data as requested and maintains report libraries. Collaborates with Managed Care Analyst Sr in modeling proposed contracts and loading finalized contracts. Oversees all contract naming conventions, organization of payor models, organization of scanned and paper contracts, rate schedules, payor correspondence, and the managed care smh.com website. Performs other duties as assigned in support of the Managed Care Department.
Require a Bachelor’s degree. Relevant progressive professional work experience will substitute on a year for year basis in lieu of Bachelor’s degree.
Require a minimum of five (5) years of experience in maintaining databases, reconciling data files, analyzing data, and generating reports
Require experience building queries and analyzing large amounts of data from contract management system.
Prefer experience in a managed care setting.
Prefer knowledge of health insurance plans and managed care contracts.
Prefer proficient excel user with experience using complex formulas and pivot tables.
Prefer previous experience in generating a variety of reports.
Prefer coding certificate (i.e. CPC) or CPAT/CRCS.
Prefer demonstrated knowledge of hospital billing, including hospital charges, CPT, DRG, APC, APRDRG, revenue codes, and ASC Groupers
Prefer demonstrated knowledge of contract modeling software, contract terms, and contract modeling.
Prefer demonstrated ability to relate to a wide variety of people using excellent written and verbal communication skills.
Prefer demonstrated organizational, analytical, leadership and judgment skills.
Prefer demonstrated proficiency with Windows-based office applications including Excel, Word, PowerPoint, Access, and Outlook.
Prefer knowledge and experience with hospital and physician billing, payer claims adjudication and analyzing payment patterns.