About Us:
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.
We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
JOB SUMMARY:
The Managed Care Analyst assists with the development and implementation of Contract Management projects, including contract maintenance for clients, analysis of data and contractual terms, and analytical projects needed by clients and internal staff.ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.
Essential Functions:
- Program managed care, Medicaid and Medicare based rates and contracts into pricing system to ensure accurate pricing of claims for several client hospital systems
- Build and update quarterly/annual rate-based calculators for Medicare and Medicare-based managed care contracts
- Maintain database of contracts and rate/fee schedules for multiple clients with attention to updates and revisions as needed
- Maintain and troubleshoot the pricing and allowancing system for client sites to ensure proper allowance of claims on a daily basis.
- Create analytical models and initiate contractual updating/administration projects as requested by upper management in response to client needs.
Qualifications and Requirements:
- Knowledge of Excel (intermediate), some comfort level with pricing programming
- Working knowledge of medical coding terms (DRG, CPT/HCPCS, revenue codes)
- Knowledge of NJ Medicaid and CMS/Medicare preferred
Physical Requirements and Demands:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.
Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, incumbents are subject to sitting for prolonged periods. Infrequently, incumbent must be able to lift and move material weighing up to 20 lbs. Incumbent may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the employee’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate
PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.