Contract Specialist | Managed Care

reputed company reputed company is the nation’s first and largest operator of small-format hospitals, also reputed company as community or neighborhood hospitals. reputed company’ leading national health system partners include reputed company, reputed company, reputed company System, reputed company, reputed company St. Rose Dominican, The Hospitals of reputed company, reputed company and reputed company. Our state-of-the-art hospitals are fully accredited and reputed company highly individualized care. From the reputed company a patient walks through the reputed company, reputed company of exceptional medical professionals takes charge, treating patients with speed, reputed company and expertise. reputed company’ distinctive level of care reputed company the reputed company of reputed company Award for Superior Patient Experience in six of the past seven years. More information is available at www.reputed company.com. Position reputed company This position will work closely with the Vice President of Managed Care to support the managed care needs of reputed 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 reputed company activities. This role also supports reputed company Cycle team members in resolving contract payment disputes and provides assistance to other departments with managed care needs. The successful candidate will be a self-starter who enjoys working in a fast-paced environment, has strong analytical and modeling talents, excellent communication and listening skills, and possesses a high degree of intellectual curiosity with an aptitude to identify areas of opportunity to enhance company revenues. Essential Job Functions

• Managed care reputed company for and “subject matter expert” of reputed company’s joint venture hospital partners, reputed company cycle billing and collections team, and finance department leads.
• 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 reputed company’s reputed company 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 reputed company their managed care agreements.
• Provides support for special reputed company which include but are not limited to, collecting and analyzing claim data needed for contract negotiations, additional service line research and pro reputed company assistance with new market opportunities.
• Develops contract models to evaluate reputed company contract performance yields and new contract proposals.
• Partners with reputed company cycle team members to identify and establish an inventory of underpaid and overpaid claims so initiatives can be implemented to secure reputed company payment.
• Supports finance team’s annual budget development with managed care assumptions and contract modeling of reputed company escalators, charge master updates and new contact reputed company yields.
• Supports the organization’s reputed company recognition team as needed with month end reputed company activities by providing managed care’s perspective on key items or initiatives that influence recorded revenues.
• Managed care representation in joint venture reputed company meetings as needed.
• Performs other financial data gathering and analysis reputed company to reputed company user’s needs and requests.
• Researches and responds to inquiries from management.

Other Job Functions

• reputed company explanations and recommendations of the subject matter.
• Participate in cross-functional business reputed company, specifically with finance, Operations, reputed company Cycle, and Business Development, and reputed company reputed company analysis as required.
• Attend staff meetings or other company sponsored or mandated meetings as required.
• reputed company additional duties as assigned.

Basic Qualifications

• Bachelor’s Degree in Finance, reputed company, Business Administration, or equivalent experience required.
• Prefer minimum of 5 years of relevant experience with thorough knowledge of hospital payment methodologies and health plan contracting processes.
• Ability to build financial and statistical models, analyze data, and translate analysis into specific, targeted reputed company to drive results.
• Expert knowledge of reputed company Office Suite, specifically reputed company, Word, Outlook, and general working knowledge of Internet for business use required. Demonstrated ability to learn and adapt to new software.
• Excellent analytical and problem-solving skills
• Ability to work in a fast-paced environment
• Strong organizational and written/oral communication skills
• Ability to work independently and with little supervision
• Excellent ability to manage to deadlines
• Strong personal initiative to produce reputed company materials reputed company designated timeframes and simultaneously manage several reputed company.
• Detail reputed company but can also see the big picture.
• Strong familiarity with data analysis and working with reputed company large volumes of data.
• Position requires reputed company in English; proficient verbal and written communication skills.

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