Managed Care Systems Analyst, Corporate Greenville, FT Days
Prisma Health | Greenville, SC, US, 29601Posted 3 hours ago
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Description
Inspire health. Serve with compassion. Be the difference.
Job Summary
The Managed Care Systems Analyst is responsible for the successful maintenance of the third party payer contract management software. The Analyst will work with third party payers, managed care staff and IS personnel in various aspects of software maintenance, focusing on contract loading and daily reconciliation of system data files. Directly supports Manager with identifying and resolving payer issues by researching, analyzing, and presenting financial information regarding the reimbursement trends affecting Greenville Health System. This includes compilation of rate data for managed care contract rate modeling and negotiations and contract compliance monitoring.Accountabilities
Responsible for daily support and data management of the contract management system including daily reconciliation of data and monitoring of data interfaces.\u00A0 Performs routine maintenance and upgrades to contract management system.\u00A0 Troubleshoots software and technical issues by reporting software issues, investigates and monitors issues and reports on completion and status in a timely and team-oriented manner. - 35%
Obtains, develops, and provides end user training programs and support materials for the contract management system.\u00A0 Responsible for granting access to end users based upon appropriate "need-to-know" basis. - 20%
Responsible for contract rate modeling of facility and physician managed care contract negotiations.\u00A0 Based on modeling outcomes, assists Manager of Managed Care develop and recommend rate structure for contracting.\u00A0- 20%
Maintains third party reimbursement contract profiles within contract management system for analysis of reimbursement trends and performance.\u00A0\u00A0- 10%
Facilitates compilation of data and resolution of issues for third party payor performance trending. - 5%
Compiles monthly and quarterly statistical data regarding managed care accounts receivable. - 5%
Maintains and updates condensed rate manuals as updates or changes dictate. - 5%
Supervisory/Management Responsibilities
- This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
- Bachelor's Degree - Prefer in Technical, Finance, or Business (Computer Science or Information Systems a plus)
- 5 years - Healthcare collections, billing and/or Patient Financial Services experience including healthcare related systems software experience
Required Certifications/Registrations/Licenses
- Not Applicable
In Lieu of the Above Minimum Requirements
- High School Diploma and 8 years related experience
Other Required Skills and Experience
- Advanced MS Excel
- Extensive Computer Skills
- Advanced Access - Preferred
- Understanding/experience in healthcare/nursing industry, preferably in training and implementation of contract management systems a plus. - Preferred
Work Shift
Day (United States of America)Location
Independence PointeFacility
7001 CorporateDepartment
70019069 Managed Care ContractingShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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Job Summary
The Managed Care Systems Analyst is responsible for the successful maintenance of the third party payer contract management software. The Analyst will work with third party payers, managed care staff and IS personnel in various aspects of software maintenance, focusing on contract loading and daily reconciliation of system data files. Directly supports Manager with identifying and resolving payer issues by researching, analyzing, and presenting financial information regarding the reimbursement trends affecting Greenville Health System. This includes compilation of rate data for managed care contract rate modeling and negotiations and contract compliance monitoring.Accountabilities
Responsible for daily support and data management of the contract management system including daily reconciliation of data and monitoring of data interfaces.\u00A0 Performs routine maintenance and upgrades to contract management system.\u00A0 Troubleshoots software and technical issues by reporting software issues, investigates and monitors issues and reports on completion and status in a timely and team-oriented manner. - 35%
Obtains, develops, and provides end user training programs and support materials for the contract management system.\u00A0 Responsible for granting access to end users based upon appropriate "need-to-know" basis. - 20%
Responsible for contract rate modeling of facility and physician managed care contract negotiations.\u00A0 Based on modeling outcomes, assists Manager of Managed Care develop and recommend rate structure for contracting.\u00A0- 20%
Maintains third party reimbursement contract profiles within contract management system for analysis of reimbursement trends and performance.\u00A0\u00A0- 10%
Facilitates compilation of data and resolution of issues for third party payor performance trending. - 5%
Compiles monthly and quarterly statistical data regarding managed care accounts receivable. - 5%
Maintains and updates condensed rate manuals as updates or changes dictate. - 5%
Supervisory/Management Responsibilities
- This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
- Bachelor's Degree - Prefer in Technical, Finance, or Business (Computer Science or Information Systems a plus)
- 5 years - Healthcare collections, billing and/or Patient Financial Services experience including healthcare related systems software experience
Required Certifications/Registrations/Licenses
- Not Applicable
In Lieu of the Above Minimum Requirements
- High School Diploma and 8 years related experience
Other Required Skills and Experience
- Advanced MS Excel
- Extensive Computer Skills
- Advanced Access - Preferred
- Understanding/experience in healthcare/nursing industry, preferably in training and implementation of contract management systems a plus. - Preferred
Work Shift
Day (United States of America)Location
Independence PointeFacility
7001 CorporateDepartment
70019069 Managed Care ContractingShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
