Managed Care Payment Analyst

Job Summary:

The Managed Care Payment Analyst will audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments. Analyst will Identify issues with contract management projections and make recommendations to Manger of Payer Relations. In addition, Analyst will review fatal technical denials and pursue additional payment under other negotiated terms, when possible. Analyst will work independently and must be able to interpret, understand, and effectively debate contract terms with payers to resolve payment disputes. The Analyst will independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to the Manager of Payer Relations. Analyst must have strong verbal and communication skills to effectively communicate with internal and external parties, including independently filing reconsiderations, payment appeals, initiating calls, and conducting meetings with payers to obtain accurate payment. Analyst must meet performance goals set by the Director and the Manager of Payer Relations to achieve organizational goals. The Analyst must maintain a thorough knowledge of all managed care agreements and must have a thorough understanding of managed care payment methodologies, including an understanding of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, and other rate methodologies. An expert knowledge of Microsoft Office products including Excel, Access, and Word is required. The Payment Analyst will participate in special projects, provide reporting, and will assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts are administered with maximum reimbursement.

Education:

Required:

Associate degree or comparable experience in a relevant role such as a senior medical high dollar hospital reimbursement analyst

Preferred:

Bachelor's Degree in related field with related experience

Experience:

Required:

Superior analytical skills and attention to detail a must.

Preferred:

Minimum three years of experience in managed care & variance follow-up in Epic

Position Requirement(s): License/Certification/Registration

Required:

None

Preferred:

Department Position Summary:

The Managed Care Payment Analyst will audit managed care claims payments and calculate reimbursement based on contract terms utilizing a contract management system, reports and other documentation to identify managed care contract underpayments. Analyst will Identify issues with contract management projections and make recommendations to Manger of Payer Relations. In addition, Analyst will review fatal technical denials and pursue additional payment under other negotiated terms, when possible. Analyst will work independently and must be able to interpret, understand, and effectively debate contract terms with payers to resolve payment disputes. The Analyst will independently identify payment trends, billing issues, or other items resulting in managed care underpayments and escalate to the Manager of Payer Relations. Analyst must have strong verbal and communication skills to effectively communicate with internal and external parties, including independently filing reconsiderations, payment appeals, initiating calls, and conducting meetings with payers to obtain accurate payment. Analyst must meet performance goals set by the Director and the Manager of Payer Relations to achieve organizational goals. The Analyst must maintain a thorough knowledge of all managed care agreements and must have a thorough understanding of managed care payment methodologies, including an understanding of MS-DRG, APR-DRG, HCPCS, CPT, APC, ICD-10, and other rate methodologies. An expert knowledge of Microsoft Office products including Excel, Access, and Word is required. The Payment Analyst will participate in special projects, provide reporting, and will assist facility personnel in interpreting and understanding complex contract terms and conditions to ensure contracts are administered with maximum reimbursement.

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