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Managed Care Support Analyst - Santa Fe New Mexico
Company: Highmark Health Location: Santa Fe, New Mexico
Posted On: 04/20/2024
Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This role processes payor contracts for single case agreements, manages contract repository, and completes facility credentialing applications. Disseminates payor communications and coordinates projects as assigned. Summarizes contract terms and payor policies for use throughout the organization. Provides accurate hospital, professional, and ASC rate information to Leaders throughout the organization. ESSENTIAL RESPONSIBILITIES -
Applies knowledge of hospital, professional, and ASC reimbursement to provide accurate and timely pricing information. (25%) -
Supports the Finance Team's reserve model by accurately calculating expected reimbursement for high dollar, complex accounts. (25%) -
Collaborates with Revenue Cycle and Finance Teams on payor policy, contract summary, and pricing requests. (20%) -
Participates in cross-functional teams that evaluate potential new products and new business initiatives. (15%) -
Provides all hospital and professional rate information required for compliance with the CMS price transparency regulation. (15%) -
Perform other duties as assigned or required. QUALIFICATIONS: Minimum -
Bachelor's Degree in Finance, Accounting, Business Administration, Economics, Statistics, or related field OR 6 years of relevant experience in lieu of Bachelor's degree. -
1 year in Finance, Contracting, or Data Analysis -
Microsoft Office (Excel, Powerpoint, etc.) -
Ability to apply various reimbursement methodologies (e.g. CMS IPPS, CMS OPPS, PA Medicaid, etc.) in pricing requests -
Ability to juggle multiple projects at once and manage time effectively, in order to meet established deadlines -
Strong oral and written communication skills -
Ability to independently make progress on key projects with support from supervisor or peer analysts -
Self-starter who takes initiative, and drives progress on major projects with some supervision Preferred |
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