Develops complex contractual reimbursement analysis to support contract negotiations performed by Administrative Director of Managed Care and Payer Strategy. Provides analytics to support the Managed Care objectives of NCHS.

Job Specific Duties

Manages contract documentation process.
Prepares and analyzes contract proposals by evaluating financial impact.
Supports contract negotiations with financial analysis.
Conducts contract audits to identify payer behavior and areas of opportunity.
Obtains and performs regular fee schedule audits of Managed Care Contracts to ensure appropriate level of reimbursement is applied.
Prepares Contract Rate Models forecasting future negotiation rates.
Mentors or coaches other analysts in the Financial Analytics team.
Develops and executes complex business plans (including financial models) and project plans to obtain new business growth for the organization.
Assists in ongoing research and maintains working knowledge of payer policies and governmental regulations.
Assists Patient Financial Services Billing and Collections departments in payer policy or reimbursement system audits.
Works cross functionally to operationalize systems and organizational changes required to comply with executed contract requirements.
Presents reimbursement results to leaders as needed.
Serves as liaison with contract management account representative to drive contract loading, and ensure accurate modeling.

Qualifications

Minimum Job Requirements

Bachelor's Degree in Business Administration, Healthcare Administration, or related field
4-7 years of experience in managed care and analytics (strategic planning, business development,
financial analysis, forecasting, and data modeling)

Knowledge, Skills, and Abilities

Master's in Business Administration, Healthcare Administration, or related field highly preferred
nThrive (previously known as MedAssets), or similar contract management tool system preferred
Prior experience using business intelligence system(s)
Knowledge of ICD9, ICD10, CPT, DRG and other coding/reimbursement schedules
Advanced Excel modeling, formulas, and automation skills
Able to create queries and manipulate data results for modeling
Ability to communicate verbally and in writing
Able to maintain confidentiality of sensitive information
Ability to problem solve and formulate a plan of action
Able to analyze and audit contracts to identify any opportunities in payment behavior
Excellent financial, analytical, communication and organizational skills
Experience in bringing together groups with diverse interests and helping groups to build common goals
Specific knowledge in a Contract Maintenance Environment for the purpose of Contract Coding and Contracts
Knowledge of reimbursement terminology and contract testing
Knowledge of healthcare reimbursements in a Managed Care environment
Demonstrates competency in financial and statistical reporting, design, preparation of spreadsheets and other financial reports
Strong problem solving skills
Skills in the use of complex mathematical and statistical techniques to assess financial and statistical scenarios
Ability to utilize discretion and independent judgment to support the financial goals of the organization
Able to communicate verbal and written information in a clear, concise and easy to understand manner for use by internal and external groups

Job :

Professional

Primary Location :

Florida-Miami-NCHS Corporate Headquarters

Department :

NCHS-MANAGED CARE CONTRACTING-1000-900910

Job Status

:Full Time

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About Nicklaus Children’s Health System

Nicklaus Children’s Health System, is the region’s only healthcare system exclusively for children. In addition to Nicklaus Children’s Hospital and a growing number of outpatient centers located throughout the tri-county area, the health system includes Nicklaus Children’s Hospital Foundation, the organization’s fundraising arm; Nicklaus Children's Pediatric Specialists, a nonprofit physician practice subsidiary; a management services organization, and an ambulatory surgery center. Our vision is to be where the children are. Ultimately, this means being there through all stages of health and life, both physically and emotionally. To be a trusted partner to children and their families, not only in times of illness, but throughout their life journey. Our mission is to inspire hope and promote lifelong health by providing the best care to every child.

Connections working at Nicklaus Children’s Health System

More Jobs from This Employer

https://careers.nahse.org/jobs/16775979/sr-managed-care-reimbursement-analyst-remote

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