Managed Care Contracting Analyst

🔥 4 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

🤝 B2B

☁️ SaaS

💰 Private equity on 2019-02

Healthcare • B2B • SaaS

Healthcare Outcomes Performance Co. (HOPCo) is the largest orthopedic value-based care organization in the U. S. , specializing in comprehensive musculoskeletal (MSK) care delivery, management, and value creation. Led by orthopedic physicians and executives, HOPCo operates an accredited MSK clinically integrated network and offers practice partnership and health system solutions, payor-facing population health and value-based care programs, analytics and outcomes reporting, and digital patient engagement tools to align stakeholders, improve outcomes, and lower total MSK costs.

📋 Description

• Prepare analyses of the financial and operational performance of healthcare contracts, including regulatory rate or other changes • Identify performance issues and recommend areas for improvement • Provide analysis for Medicaid and other managed care products, including HMO, PPO, and POS products • Monitor and trend third-party reimbursement, including denial analysis • Create financial models and reports for existing and new reporting needs • Support management by locating data sources and collecting data under tight time constraints • Identify and analyze 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 changes in application utilization to Revenue Cycle • Create queries to extract financial and claims data for 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 outcomes • Analyze health-payor optimization within each market • Create and schedule JOCs with applicable health-plan representatives for each market • Update and audit the Clearwave system to maintain current provider information • Extract, query, and compile data from multiple sources into 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 • Two or more years’ experience with Revenue Cycle Billing • Experience using relational databases, decision support systems, analysis and modeling • 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 be organized and efficient in daily work activities/projects • Ability to exercise independent judgment and decision-making abilities • Core Creed must be read and signed • OSHA requirements and training, including safety training

🏖️ Benefits

• Full-Time employment • Normal office environment • OSHA safety training