Job Description
Role Description
- This role collaborates closely with the Vice President of Managed Care to support the company and its joint venture hospital partners. Key responsibilities include:
- Managing contract databases
- Interpreting critical contract terms
- Developing and automating payer contract models
- Validating data
- Conducting financial analysis
- Ensuring federal price transparency compliance
- Contributing to annual budgeting and month-end close processes
- Providing support to Revenue Cycle and Revenue Recognition teams on payer-related issues and contract disputes
- Assisting other departments as needed
The ideal candidate is a proactive self-starter who thrives in a dynamic, fast-paced environment. They possess strong analytical and modeling skills, excellent communication and listening abilities, and a keen intellectual curiosity to identify opportunities for improving departmental efficiency and enhancing company revenue.
- Qualifications
- Bachelor’s degree in Finance, Accounting, Business Administration, or equivalent experience required
- Minimum of 3 years of healthcare experience preferred, with deep knowledge of hospital payment methodologies and health plan contracting processes
- Proven ability to build financial and statistical models, analyze data, and drive actionable results
- Excellent organizational, written, and verbal communication skills
- Advanced Microsoft Excel modeling skills (required); proficiency in Word, PowerPoint, and Outlook (essential)
- Ability to write efficient queries for data retrieval, filtering, and manipulation using SQL
- Intermediate knowledge of data preparation and visualization techniques using PowerBI
- Strong analytical and problem-solving capabilities
- Comfortable working in a fast-paced environment with minimal supervision
- Ability to meet deadlines while managing multiple projects and delivering high-quality work
- Detail-oriented with a strategic, big-picture mindset
- Requirements
- Serve as the managed care liaison and subject matter expert for joint venture hospital partners, revenue cycle billing and collections teams, and finance department leaders
- Compile and analyze payer performance metrics for reporting to organizational leadership
- Maintain up-to-date managed care contract databases to streamline collections, support analysis, and share contract terms efficiently
- Assist the revenue cycle team by loading and maintaining current payer rates in an insured allowed/payment validation module
- Perform random audits of claim payments to ensure payer compliance with managed care agreements
- Support special projects, including claim data analysis for contract negotiations, service line research, and pro formas for new market opportunities
- Build contract models to assess current performance yields and evaluate new contract proposals
- Collaborate with the revenue cycle team to identify underpaid/overpaid claims and develop initiatives to secure accurate payments
- Provide managed care insights and contract modeling (e.g., rate escalators, charge master updates, new contract yields) to support the finance team’s annual budget process
- Assist the revenue recognition team during month-end close by offering managed care perspectives on key revenue-influencing items
- Ensure compliance with federal and state price transparency regulations by preparing and maintaining required files
- Represent managed care in joint venture board meetings or monthly operational reviews as required
- Conduct financial data analysis and respond to internal/external inquiries from management
- Benefits
- Provide clear explanations and actionable recommendations on managed care topics
- Contribute to cross-functional projects with Finance, Operations, Revenue Cycle, and Business Development, delivering ad-hoc analysis as needed
- Attend required staff meetings, company-sponsored events, or mandated gatherings
- Take ownership of personal professional development
- Perform additional duties as assigned
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