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Role Description

This role provides data retrieval, contract modeling, and financial analysis support to the VP and Managed Care Regional Contracting Directors.

• Retrieves reimbursement data from hospital accounting systems.
• Builds financial models to analyze and evaluate the reimbursement impact of hospital and physician payer reimbursement methodology proposals, including Bundled Payment Models and concepts.
• Works with Managed Care Regional Contracting Directors on contract interpretation issues to ensure accuracy of contract models and financial analysis.
• Produces clear and concise written reports summarizing payment modeling analysis.
• Assists in periodic projects to report on industry reimbursement trends.
• QA monthly data loads.
• Completes special projects/reports as needed.

Qualifications

• Well versed in reimbursement methodology including DRG, APC, COPPS, OPPS, Case Rates, and Per Diems (minimum 4 years’ experience).
• Familiar with hospital billing and coding terminology including diagnostic codes, revenue codes, procedure codes, and HCPCS codes.
• Well versed in healthcare product lines including HMO, PPO, HIX, Medicare, Medicaid, Tricare, Workers Comp.
• Must be able to clearly communicate complex and technical issues in writing and verbally.
• The ability to assist with the training and mentoring of Associates and Analysts.

Requirements

• Bachelor’s degree required; emphasis in Accounting or Data Analytics preferred.
• Five (5) years’ work experience required.
• Prior experience in hospital or health plan financial analysis, or equivalent experience preferred.
• Knows/has modeled/worked with health plan/hospital and physician managed care commercial and Medicare reimbursement methodologies and terminology.