Managed Care Support Analyst
Company: Highmark Health
Location: Santa Fe
Posted on: April 19, 2024
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Job Description:
Company :
Allegheny Health Network
Job Description :
GENERAL OVERVIEW:
This role processes payor contracts for single case agreements,
manages contract repository, and completes facility credentialing
applications. Disseminates payor communications and coordinates
projects as assigned. Summarizes contract terms and payor policies
for use throughout the organization. Provides accurate hospital,
professional, and ASC rate information to Leaders throughout the
organization.
ESSENTIAL RESPONSIBILITIES
Applies knowledge of hospital, professional, and ASC reimbursement
to provide accurate and timely pricing information. (25%)
Supports the Finance Team's reserve model by accurately calculating
expected reimbursement for high dollar, complex accounts. (25%)
Collaborates with Revenue Cycle and Finance Teams on payor policy,
contract summary, and pricing requests. (20%)
Participates in cross-functional teams that evaluate potential new
products and new business initiatives. (15%)
Provides all hospital and professional rate information required
for compliance with the CMS price transparency regulation.
(15%)
Perform other duties as assigned or required.
QUALIFICATIONS:
Minimum
Bachelor's Degree in Finance, Accounting, Business Administration,
Economics, Statistics, or related field OR 6 years of relevant
experience in lieu of Bachelor's degree.
1 year in Finance, Contracting, or Data Analysis
Microsoft Office (Excel, Powerpoint, etc.)
Ability to apply various reimbursement methodologies (e.g. CMS
IPPS, CMS OPPS, PA Medicaid, etc.) in pricing requests
Ability to juggle multiple projects at once and manage time
effectively, in order to meet established deadlines
Strong oral and written communication skills
Ability to independently make progress on key projects with support
from supervisor or peer analysts
Self-starter who takes initiative, and drives progress on major
projects with some supervision
Preferred
Master's Degree in Finance, Accounting, Business Administration,
Economics, Statistics, or related field
1 year with hospital, physician, and ASC contracts
1 year in Healthcare
Knowledge of healthcare industry, particularly as it relates to
hospitals or other providers
Clinical background or general understanding of hospital/physician
practice operations
Expected Reimbursement Contracts certification
Disclaimer: The job description has been designed to indicate the
general nature and essential duties and responsibilities of work
performed by employees within this job title. It may not contain a
comprehensive inventory of all duties, responsibilities, and
qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal
standards and behavioral expectations as set forth in the code of
business conduct and company policies.
As a component of job responsibilities, employees may have access
to covered information, cardholder data, or other confidential
customer information that must be protected at all times. In
connection with this, all employees must comply with both the
Health Insurance Portability Accountability Act of 1996 (HIPAA) as
described in the Notice of Privacy Practices and Privacy Policies
and Procedures as well as all data security guidelines established
within the Company's Handbook of Privacy Policies and Practices and
Information Security Policy.
Furthermore, it is every employee's responsibility to comply with
the company's Code of Business Conduct. This includes but is not
limited to adherence to applicable federal and state laws, rules,
and regulations as well as company policies and training
requirements.
Pay Range Minimum:
$30.82
Pay Range Maximum:
$48.21
Base pay is determined by a variety of factors including a
candidate's qualifications, experience, and expected contributions,
as well as internal peer equity, market, and business
considerations. The displayed salary range does not reflect any
geographic differential Highmark may apply for certain locations
based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against
qualified individuals based on their status as protected veterans
or individuals with disabilities, and prohibit discrimination
against all individuals based on their race, color, age, religion,
sex, national origin, sexual orientation/gender identity or any
other category protected by applicable federal, state or local law.
Highmark Health and its affiliates take affirmative action to
employ and advance in employment individuals without regard to
race, color, age, religion, sex, national origin, sexual
orientation/gender identity, protected veteran status or
disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected
Veterans/Disabled/Sexual Orientation/Gender Identity (
https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf
)
We endeavor to make this site accessible to any and all users. If
you would like to contact us regarding the accessibility of our
website or need assistance completing the application process,
please contact number below.
For accommodation requests, please contact HR Services Online at
HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and
Applicants Notice
Req ID: J241209
Keywords: Highmark Health, Santa Fe , Managed Care Support Analyst, Professions , Santa Fe, New Mexico
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