Senior Managed Care Contract And Data Analyst
CurrentWorks closely with the Vice President of Managed Care to support the managed care needs of the company and its affiliated joint venture hospitals. Responsibilities include maintaining contract databases, interpreting key contract terms, contract yield modeling, data validation, financial analysis and participation in annual budgeting and month-end close activities. • Prepares, compiles, and consolidates payor performance metrics data for reporting to organizational leadership.• Maintains a managed care contract database to aid in streamlining collections activity, analysis and the dissemination of contract details and terms.• Supports the company’s revenue cycle team by loading and maintaining up to date contracted payor rates in an insured allowed/payment validation collections module.• Conducts random audits on claim payment activity to ensure payors are honoring the agreed to terms within their managed care agreements.• Provides support for special projects which include but are not limited to, collecting and analyzing claim data needed for contract negotiations, additional service line research and pro forma assistance with new market opportunities.• Develops complex contractual models to evaluate current contract performance yields and new contract proposals.• Partners with revenue cycle team members to identify and establish an inventory of underpaid and overpaid claims so initiatives can be implemented to secure proper payment.• Supports finance team’s annual budget development with managed care assumptions and contract modeling of rate escalators, charge master updates and new contact revenue yields.• Supports the organization’s revenue recognition team as needed with month end close activities by providing managed care’s perspective on key items or initiatives that influence recorded revenues.• Performs other financial data gathering and analysis related to internal and external needs and requests.