Managed Care Financial Analyst

NGHS: Opportunities thrive here.

Job Summary

Performs a wide range of complex managed care analytical and operational functions. Performs office procedures in support of managers. This position is responsible for managed care financial analysis, modeling and analyzing contract proposals, contract loading in both the Epic contract applications and the contract management system. This position is responsible for providing system-level support for Epic contract applications which include technical build, configuration, migration, maintenance and production support. This position works on complex problems where analysis of situations or data requires an in-depth evaluation and knowledge of the contract application. This person may also assist with contract negotiation processes as needed, make recommendations to the Managed Care negotiators regarding terms of the contract. This person will act as a liaison between contract management platform system administrators, IT Analysts and leadership, Revenue Cycle, and the Managed Care negotiators for resolution and feedback of any related items. This person may work with managed care payors to resolve claims and related issues in order to enhance managed care contract performance. Supports multiple managed care functions, including but not limited to Epic data integrity, contract management system integrity, managed care contract negotiations, and managed care payer relations, including both claim and operational issues, all in support of the Health System revenue cycle function. This position provides reports for the Medical Economics Manager and/or Contracts Integrity Managers concerning payment variance issues. 

Minimum Job Qualifications

Bachelor's Degree and 2 years of related managed care contracting and/or billing/collection experience in a hospital and/or managed care payor setting; or in lieu of Bachelor's Degree 5+ years of relevant experience.

Epic Resolute HB/PB contract build experience preferred.

Epic reimbursement contract loading and/or government reimbursement experience preferred.

Epic Resolute Hospital Billing Expected Reimbursement Contracts Management Certification preferred
Epic Resolute Hospital Billing Expected Reimbursement Contracts Administration Certification preferred

Essential Tasks and Responsibilities                                                         

1. Able to understand and interpret Managed Care Contracts. Research, collect, and analyze contract information as required.  

2. Ability to accurately build contracts into the contract management system and Epic contract applications.                                                                                                               

3. Modeling contracts to determine appropriate financial terms.                                                                    

4. Management of the process involved with identifying, analyzing, and resolving financial calculation issues between payer and provider.       

5. Possess a specific knowledge of Third-Party Healthcare Arrangements and is able to apply that knowledge.

6. Must be able to calculate and audit expected reimbursement in order to determine accuracy of payment.

7. Must be willing to learn and act as a “System Administrator.”

8. Must be able to make the appropriate payment classifications determination and record it accurately in the system.

9. Continually seeks ways and means for improving the delivery and support of Managed Care Modeling & Reimbursement System feedback.

Relocation allowance for out of state candidates

Medical, Dental, Vision, 401k, up to 24 days PDO for FTE

#CB

Northeast Georgia Health System strongly believes in our quest for excellence. Part of our quest is to help you find a new opportunity to expand your knowledge. We are thrilled you want to learn a new area at NGHS and are excited to see you grow!

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

Posted
01/01/2022
Type
Full time
Salary Range
$61,000.00 - 122,000.00
per Year
Salary range estimated by
Location
Gainesville, GA 30501, US
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