Managed Care Analyst

At NorthBay Health, the Managed Care Analyst is responsible for supporting provider enrollment, contracting and contract performance initiatives. The position is responsible for supporting process improvement for all managed care activities as well as overseeing the implementation and on-going support of the Experian and EPIC contract management applications.

PRIMARY JOB DUTIES

• Serves as a resource in credentialing standards for NCQA, CMS, Medi-Cal, medical group affiliates and health plans.
• Monitors current regulations and enrollment guidelines for payers of all current and future healthcare services.
• Proficient in PECOS, PAVE, CAQH, Better Doctors, MD-Staff and other credentialing and enrollment software and websites, and other tools required to enroll, credential and terminate providers.
• Supports, as needed, enrollment activities and tracks progress toward established timelines.
• Coordinates the contract configuration of Experian and EPIC contract manager applications, including updating fee schedules, newly contracted terms, and any administrative policy edits needed to accurately record expected contract reimbursements.
• Manages with Director and Vice President contract performance reporting and prepares contract analytics for negotiations.
• Supports the Ntracts Managed Care contract management system by loading and configuring key contract terms for all Managed Care agreements.
• Performs special projects as assigned by Director or Vice President.
• Cross trains with other department Analysts to assist with various system maintenance, updates, etc.
• Enhances professional growth and development through educational programs or seminars.
• Maintain effective working partnerships internally and externally to support provider enrollment efforts.
• Works independently utilizing a high level of initiative, judgement and critical thinking skills.
• Education: Bachelor's Degree preferred in statistics, business, finance, healthcare, economics or related field required.
• Experience: Minimum of two to three years of related professional experience in designing, producing and interpreting quantitative and qualitative analysis.
• Skills:
• Healthcare industry knowledge, as exemplified by working knowledge of DRG''s and ICD-10 codes, service lines, and specialty medicine is preferred.
• Demonstrates healthcare experience preferred, with emphasis on business analytics and market assessment skills.
• Demonstrates strong analytical, problem solving, strategic thinking, critical thinking, decision modeling and organizational skills.
• Demonstrates knowledge of Finance, contracting terminology, revenue cycle, including ability to perform financial analyses.
• Demonstrates proficiency in Excel, PowerPoint, Word, MDStaff, Experian Contract Manager, EPIC Payer Contract Management, EPIC Tapestry and Access.
• Proficiency with dashboard designing software and data query tools (Tableau, Business Objects, AltoSoft, and/or SQL) is desirable but not required.
• Demonstrates ability to work in a team environment.
• Demonstrates excellent written and oral communication skills. Must be able to produce examples of written reports.
• Demonstrates ability to prepare and present high level presentations. Must be able to produce examples of presentations and related support materials.
• Demonstrates people skills, including ability and comfort with developing external contacts for information collection and benchmarking.

Physical Effort: Attendance is an essential function of the job. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee may participate in the following activities: frequent sitting and much work on a computer; occasional lifting or moving boxes/supplies, squatting, standing, walking and occasionally driving a car.

Hours of Work: Prescheduled hours, Monday through Friday, based on business need.