Revenue Cycle Analyst Managed Care

Responsible for contract management, project management and associated reporting to support internal/external customers and assure compliance with state, federal and other regulatory agency requirements.

Maintains an understanding of the key elements of a payer contracts (commercial, Medicare advantage, Medicaid HMO),  including reimbursement requirements.

Reviews contracts and makes recommendations to ensure standardization and consistency in payer agreements. ∙ Performs audits to validate payer compliance with contracts by using various standard reports, data integrity testing and claimreconciliation payment data. Identifies opportunities and makes recommendations to renegotiate contacts, in order to maximizehospital reimbursement levels.

Performs quality control measures on contract processes, including system setup, claim adjudication and payment reconciliation. ∙ Drafts contract documents and letters to payors.

Models DRG reimbursement, CPT or UB Code based reimbursement and simple and complex contracts. ∙ Updates all necessary elements of the reimbursement summary. Analyzes and researches account(s) for contract interpretation errors or incorrect payments and pursues additional  payment if necessary. Researches payor medical policies for coverage issues or for contract compliance. Organizes and provides data support for all payor issues in anticipation of a payor meetings. Leads payor meetings and ensures that all necessary documents/analysis are provided by deadlines. Researches new types of insurance product offerings through a variety of sources. Obtains and analyzes the various filings by insurance companies to the department of insurance. Prepares monthly variance reports. Reviews monthly contractuals to determine cause of any variances. Prepares the budget/forecast model for contractuals.

Responsible for the Decision Support System generation and analysis of the following:

Detailed Patient Listings

Case Mix / Payor Mix

Expected vs Actual Payments

Data for use in and completion of Project Analysis

Budget Modeling

Net Revenue Modeling

Models all elements of contract for Revenue Cycle Processing

Responsible for maintaining a working knowledge of the following:

Collections and posting process.

Interaction between all aspects of the revenue cycle.

Interaction of the chargemaster, coding and expected reimbursement.

Associate's degree in Business Administration or related field

4-6 years experience

Five years of experience in a hospital or medical insurance business office setting

An equivalent combination of educationand/orexperience may be considered.

Experience in training and development activities

Preferred:

Experience working with managed care contracts, including contract negotiation and analysis

Electronic Medical Record (EMR) experience preferred; Cerner strongly preferred.

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.