Managed Care Analyst - Modeler

November 6

🇺🇸 United States – Remote

🌲 North Carolina – Remote

Although this job is listed in North Carolina, this company may be open to hiring remote in other states.

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

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Atrium Health Wake Forest Baptist

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Preventive Care • Specialized Care • Children's Hospital • Comprehensive Cancer Center • Digestive Health Center

10,000+ employees

⚕️ Healthcare Insurance

Description

• Responsible to managed care reimbursement schemes for net revenue, contractual discount and contribution and net margins. • Models the impact of proposed reimbursement schemes for facility, physician and ancillary managed care contracts and monitors actual results against the modeled projections. • Models and analyzes proposed managed care reimbursement schemes for net revenue, contractual discount and contribution, and net margins. • Comprises hospitals, physicians, ancillary and free standing outpatient centers for owned, leased, managed and affiliated providers. • Develops objectives for reimbursement scenarios with the contract negotiating team, then provides timely written and verbal communication of the results. • Develops, designs and executes analyses to profile the financial performance of specific payors against other payors and against the portfolio average to assist in the strategy development for contract negotiations. • Provides consultation to the contract negotiating team on the key reimbursement drivers for each model to assist them in their responses during the negotiation process. • Provides input to the developers on functional design, data components and other parameters that impact the efficiency and accuracy of the modeling tools. • Performs routine and regular analysis of the contracts' performance in comparison to the modeled results; details and communicates the key drivers of any variance detected. • Assists team members in codifying the final contract terms into the contract management system.

Requirements

• Bachelor's Degree is required, MBA or MHA preferred. • Minimum of two years in provider managed care is preferred but will consider candidates with three or more years experience in managed care payor or hospital decision support. • Advanced skills in MS Excel and Access are required. • Excellent Excel skills SQL skills and have experience working with large datasets • Very good Analytical skills, questions processes and results • Health reimbursement experience either government or managed care terms and methodologies