Payer & Managed Care Analyst

Job Summary Reporting directly to the Payer Contracts Manager, the Payer Contracts Analyst is responsible for payer contracting analytics. Reviews and monitors contract/payer performance. Responsible for maintaining accurate payer rate information in hospitals systems. Responsible for overseeing ad hoc analysis in support of various HMNH initiatives.

Licensure and Certification: N/A

Education: Minimum Bachelors Degree in economics, accounting, finance, healthcare policy, business administration. Preferred Masters Degree in economics, accounting, finance, healthcare policy, business administration.

Experience: Minimum of three (3) years of experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and managed care provider reimbursement methodologies.

Knowledge and Skills:

• Excel
• Advanced knowledge of complex functions.
• Advanced ability reading, creating and interpreting computer and mathematical rules and formulas.
• Advanced ability to create complex, dynamic models in which multiple scenarios can be created and compared by manipulation of key variables.
• Hospital EMR and Billing Systems
• Minimum of three (3) years of experience with hospital EHR, Billing and other financial systems.
• Prefer 5 years of experience with hospital EHR, Billing and other financial systems with experience building and maintaining system rules.
• Proficiency with word processing and presentation programs such as MS Word and PowerPoint, with a preference for knowledge and proficiency with MS Access.
• Working knowledge of healthcare financial statements and accounting principles.

Physical Demands - Clerical/Administrative Non-Patient Care:

• Frequent sitting and standing/walking with frequent position change.
• Continuous use of bilateral upper extremities in fine motor activities requiring fingering, grasping, and forward reaching between waist and chest level.
• Occasional/intermittent reaching at or above shoulder level.
• Occasional/intermittent bending, squatting, kneeling, pushing/pulling, twisting, and climbing.
• Occasional/intermittent lifting and carrying objects/equipment weighing up to 25 pounds.
• Continuous use of near vision, hearing and verbal communication skills in handling telephone calls, interacting with customers and co-workers and performing job duties.

Key for Physical Demands

• Continuous: 66 to 100% of the time
• Frequent: 33 to 65% of the time
• Occasional: 0 to 32% of the time