Managed Care Contracting Analyst

Job not on LinkedIn

🔥 33 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Southeast Orthopedic Specialists

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2001

🏥 Healthcare

🧘 Wellness

⚽ Sports

Healthcare • Wellness • Sports

<Southeast Orthopedic Specialists> is a regional medical practice providing comprehensive orthopedic and spine care across Northeast Florida and Southeast Georgia. The group offers surgical and non-operative treatments, physical therapy, imaging (including MRI), chiropractic services, pain management, podiatry, and ambulatory surgery centers, with urgent walk-in clinics and a team of board-certified, fellowship-trained specialists focused on musculoskeletal health and sports medicine.

📋 Description

• Prepare analyses of the financial and operational performance of healthcare contracts, including regulatory rate and other changes • Identify performance issues and recommend areas for improvement • Analyze 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 within required timelines 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 • Analyze health payor optimization within each market • Create and schedule JOCs with applicable health-plan representatives • Update and audit the Clearwave system to keep provider information current • 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 • 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 organize and efficiently manage daily work activities/projects • Ability to exercise independent judgment and decision-making • Ability to meet demanding deadlines • CORE Creed must be read and signed • OSHA requirements and training, including safety training

🏖️ Benefits

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