Managed Care Analyst

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  • North Kansas City Hospital
  • REIMBURSEMENT
  • Professional-Non Clinical
  • DAYS
  • FT
  • Req #: 23537-18453
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Summary

SUMMARY: Under the direction of the Reimbursement and Managed Care Analytics Director, the Managed Care Analyst is responsible for helping ensure the financial health of North Kansas City Hospital (NKCH) and Meritas Health through support of enterprise managed care activities. Responsibilities include the following:

  • Loading, modeling, support and maintenance of the managed care contracts and fee schedules within the contract management system, including both hospital and professional agreements.
  • Participates in contract modeling and other financial analysis using significant amounts of data that must be interpreted to inform decision-making by the managed care contracting and operations teams.
  • Requires a deep understanding of healthcare reimbursement for hospitals and medical groups, contract negotiation concepts, financial analysis, and functionality of contract management databases. Works closely with Managed Care, Patient Financial Services, Revenue Integrity, Business Intelligence, and Meritas Business Office.


EXPERIENCE: Minimum 2 years of experience in a Health System or Managed Care Organization (MCO), with demonstrated experience in healthcare analytics. Demonstrated experience in problem-solving and project management.Experience with contract management and modeling software, managed care principals, hospital and professional coding, reimbursement, and financial terms such as DRG, CPT, HCPCS, ICD-10, APC, ASC groupers, chargemaster, revenue codes and payor policies preferred. Experience with Cerner Patient Accounting preferred.

SPECIAL SKILLS: Highly skilled in data collection, data analysis (Power BI), advanced Excel knowledge (including pivot functionality and advanced formulas), and relational databases. Experience with database extraction of patient accounting, medical records, and patient healthcare record data. Knowledge of hospital and physician reimbursement methodologies (i.e. DRG, per diem, fee schedule, APC). Working knowledge of billing/coding terminology (i.e. ICD-10, CPT, Revenue codes).

OTHER: Excellent organization and attention to detail required; ability to communicate complex information to various audiences; ability to work in a fast-paced environment; ability to problem-solve issues where analysis is required; decisions and actions have direct impact on hospital financials; ability to work independently, and as part of a team. The ability to multitask and prioritize multiple tasks to meet deadlines. Takes ownership of job, proactively responding to commitments. Takes specific actions to improve own work methods or systems. Develops and implements new and unique ideas.

LICENSE/CERT: Preferred: CCS (Certified Coding Specialist)

EDUCATION: Required: Bachelors - Business, Bachelors - Finance, Bachelors - Accounting, Bachelors - Health Care Management

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