Payer & Managed Care Analyst

Job Summary

Reporting directly to the Payer Contracts Manager, the Payer Contracts Analyst is responsible for payer contracting analytics. Reviews and monitors contract/payer performance. Responsible for maintaining accurate payer rate information in hospital’s systems. Responsible for overseeing ad hoc analysis in support of various HMNH initiatives.

Licensure and Certification:

• N/A

Education:

• Minimum Bachelor’s Degree in economics, accounting, finance, healthcare policy, business administration.
• Preferred Master’s Degree in economics, accounting, finance, healthcare policy, business administration.

Experience:

• Minimum of three (3) years of experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and managed care provider reimbursement methodologies.

   

Knowledge and Skills:

• Excel
  o Advanced knowledge of complex functions.
  o Advanced ability reading, creating and interpreting computer and mathematical rules and formulas.
  o Advanced ability to create complex, dynamic models in which multiple scenarios can be created and compared by manipulation of key variables.

   

• Hospital EMR and Billing Systems
  o Minimum of three (3) years of experience with hospital EHR, Billing and other financial systems.
  o Prefer 5 years of experience with hospital EHR, Billing and other financial systems with experience building and maintaining system rules.
  o Proficiency with word processing and presentation programs such as MS Word and PowerPoint, with a preference for knowledge and proficiency with MS Access.

   

• Working knowledge of healthcare financial statements and accounting principles.