Managed Care Contracting Analyst

🔥 0 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 10%

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Healthcare Outcomes Performance Co. (HOPCo)

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

☁️ SaaS

🤝 B2B

💰 Private equity on 2019-02

Healthcare • SaaS • B2B

Healthcare Outcomes Performance Company (HOPCo) is the largest orthopedic musculoskeletal (MSK) value-based care organization in the U. S. It is physician-led and provides comprehensive MSK care delivery and management services: advanced practice management, health system MSK service-line optimization and market transformation, payor solutions, and practice partnerships. HOPCo operates a URAC-accredited MSK clinically integrated network, runs population health and value-based care programs, and offers digital patient engagement, outcomes reporting, and analytics platforms to align stakeholders, improve outcomes, and reduce total cost of MSK care.

📋 Description

• Prepare analyses of the financial and operational performance of healthcare contracts, including regulatory rate and other changes • Identify performance improvement opportunities • Analyze Medicaid and other managed care products, including HMO, PPO, and POS products • Monitor and trend third-party reimbursement and perform denial analysis • Create financial models and reports • Support management by locating data sources and collecting data under tight time constraints • Identify utilization patterns driving healthcare costs and recommend actions to improve financial performance • Review shared-risk claims, capitation, risk-pool settlements, and health-plan reports • Submit shared-risk discrepancy reports according to health-plan deadlines and formats • Create payor reimbursement reports for senior leadership • Recommend utilization-related application changes to Revenue Cycle • Query financial and claims data to develop analytical and statistical models • Identify and communicate trends and potential issues to management • Serve as liaison between health plans and Revenue Cycle • Collaborate with Contracting/Credentialing to optimize health-payor reimbursement • Analyze health-payor optimization within each market • Create and schedule JOCs with applicable health-plan representatives • Update and audit the Clearwave system to maintain current provider information • Extract and query data from multiple sources and systems, compiling written and verbal reports and presentations

🎯 Requirements

• High school graduate or equivalent • Bachelor’s Degree in Finance or Healthcare Administration preferred • Minimum of three years’ experience working in an analytic or analyst role in a healthcare environment • In-depth knowledge of physician reimbursement • Experience using relational databases, decision support systems, analysis and modeling • Two or more years’ experience with Revenue Cycle Billing • Knowledge of the payor reimbursement process • Knowledge of computer systems • Knowledge of Health Plan Billing claim paperwork and timelines • Knowledge of Health Plan Billing timelines and regulations • Ability to establish good working relationships with internal and external customers • Ability to communicate effectively with staff, leadership, health plan representatives, and other departments • Ability to organize and efficiently manage daily work activities/projects • Ability to exercise independent judgment and decision-making • Must read and sign the CORE Creed • OSHA requirements and safety training

🏖️ Benefits

• Full-time employment • OSHA safety training • CORE Creed must be read and signed