Contract Managed Care Analyst

Candidate must reside in California

At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

Position Summary

At the direction of the Managed Care Contract Coordinator, this position is responsible for the loading and maintenance of the Contract Management System at each facility. The Analyst will work closely with Managed Care in generating and reviewing system data, while making strategic recommendations.

Review managed care payor contracts with a focus on interpreting and implementing reimbursement terms in a multi-functional approach to Managed Care strategies. Analyze relevant data to provide reports, which includes determining the impact of adjustments to managed care reimbursement terms and/or contract compliance, along with rate modeling necessary for contract negotiations. Collaborate with Payment Specialist team to determine accuracy of insurance payments. These duties will require the use of many complex and varying guides, systems, regulations, and tools.

This position requires the use of critical thinking skills to interpret complex managed care contracts to maintain the Hospital Billing Contract Management System and ensure estimated reimbursement is calculating maximum and correct reimbursement. Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct payments. Reviews contracts and makes suggestions regarding improvement and clarification. Has knowledge of highly detailed concepts, practices, and procedures within Admitting, Patient Accounting, and departmental charging practices and uses this knowledge to identify and troubleshoot problems affecting appropriate payment and estimated reimbursement. Utilizes and applies the appropriate California and Federal regulations in order to assure compliance.

This position requires the full understanding and active participation in fulfilling the mission of MHS and its hospitals. It is expected that the employee demonstrate behavior consistent with the core values of MHS. The employee shall support the MHS strategic plan. The employee will also be expected to support all organizational expectations including, but not limited to; Customer Service, Patient’s Rights, Confidentiality of Information, Environment of Care and MemorialCare initiatives.

Essential Functions and Responsibilities of the Job

1. Reviews contracts to estimate reimbursement, identify possible interpretation issues, and collaborates with Coordinator and/or Revenue Cycle team to make decisions on loading options to ensure maximum and accurate reimbursement.

2. Enters managed care contracts into the Financial Contract Management System

3. Is a resource for Managed Care and independently problem solves contract questions, including interpretation of contract language.

4. Analyzes charge and supply data to identify and resolve lost revenue or compliance opportunities.

5. Collaborates with internal resources regarding charge practices, admission procedures and Patient Accounting processes.

6. Is a resource to resolve, and answer difficult problems presented by hospital and corporate personnel.

7. Makes suggestions for enhancements throughout the department and continually seeks opportunities to improve current policies, procedures, and practices.

8. Performs other duties, as assigned.

9. Strong organizational skills with the competence to work independently and prioritize responsibilities.

10. Innovative with the ability to multitask, analyze, problem-solve with one-touch resolution, and think critically in a fast-paced environment.

11. Adheres to all patient confidentiality policies and carries out all tasks in a pleasant and respectful manner.

12. Knowledge of industry-specific terminology, billing and collections principles and best practices with complete understanding of relevant laws, rules and regulations.

13. Comfortable working remotely in a private and professional workspace with a fast, reliable internet connection.

14. This position offers the opportunity to work from home (WFH) after all training has been completed. Once completed, analyst will need to be available to come into the office for additional training, meetings etc., as needed.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time-to-time, as needed.

Qualifications

Minimum Requirements

Qualifications/Work Experience:

• Minimum 5 years of experience in managed care, Patient Financial Services, claims pricing, or provider payment methodologies for acute hospital settings.
• Working knowledge of health care reimbursement practices, claims handling procedures, and health insurance benefit administration.
• Experience working with Medicare, Medicaid, and other commercial insurances.
• Experience with contract management/analytic tools.
• Experience with billing requirements, CPT, HCPC, ICD10, UB04 coding, and medical terminology.
• Ability to solve complex problems and adapt to process variances in situations where limited standardization exists.
• Excellent written and presentation skills to easily communicate to diverse audiences.
• Good time management and organizational skills to balance multiple priorities in a fast-paced working environment.
• Certification in Epic Resolute Hospital Billing or Reimbursement Contracts and experience, preferred.
• Proficient in Microsoft Suite Applications, preferred.

Education/Licensure/Certification:

• Bachelor’s degree, preferred.
• Associate degree or medical field certificate, preferred.
• Business related courses, preferred.
• High School diploma, GED equivalent, preferred.

Job Type: Full-time

Pay: $38.71 - $56.14 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Relocation assistance
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift

Application Question(s):

• • Minimum 5 years of experience in managed care, Patient Financial Services, claims pricing, or provider payment methodologies for acute hospital settings.

• Working knowledge of health care reimbursement practices, claims handling procedures, and health insurance benefit administration.

• Experience working with Medicare, Medicaid, and other commercial insurances

Experience:

• Managed care, PFS, claims pricing, or provider payment: 5 years (Required)

Work Location: Hybrid remote in Fountain Valley, CA 92708