White Plains Hospital
Overview
Managed Care Analyst The Managed Care Analyst is responsible for analytics, reporting, trending, and validation of reimbursement from third party plans in relation to the hospital's negotiated fees and adherence to contract terms. The role includes testing and maintenance of contract software, host system contract builds, and fee schedule loading. The Analyst prepares reports on contractual variances and payer issues for leadership and collaborates with the Managed Care Contracting team to resolve discrepancies. The position also maintains relations with payer representatives and oversees the provider escalation process and file maintenance. Responsibilities
Understands and adheres to the WPH Performance Standards, Policies and behaviors. Support special projects by collecting, analyzing, and modeling claim data in preparation for payer contract negotiations at least four months in advance of contract renewal. Analyze reimbursement using rates based on contract structure. Assist in testing and maintenance of contracts, including fee schedules in the host system and contract software tools. Assist with testing of contracts to confirm methodology, including matching current contract terms and rates. Assist in preparing a contract reference guide and summary of terms for loading and distribution to the revenue cycle team. Perform audits and reconciliation of plan payments to contract terms, identify variances, and communicate issues to leadership and the Managed Care team. Collaborate with third-party payers to rectify contract discrepancies identified through payment audits. Prepare and maintain provider representative escalation files. Take meeting minutes and provide updates to leadership on provider representative JOC calls. Assist with data preparation and terms for contract modeling. Assist with quality measurement of contract modeling application for accuracy. Maintain knowledge of state and federal regulations, monitor payer policy changes, and communicate updates to HQ staff as appropriate. Conduct revenue cycle analysis, trend analysis, prepare month-end reports, and assess plan contract performance and progress. Provide analysis, reporting, and recommendations for plan-specific contracts and future negotiations to Senior Management and the Managed Care Team. Assist with audits of plan payments and denials to ensure adherence to contract terms and escalate findings as needed. Maintain knowledge of third-party reimbursement policies and practices. Track, trend, and report on initiatives and projects to senior leadership. Ensure compliance with hospital and Human Resources policies and that competency and education requirements are satisfied as per policy. Participate in the Performance Improvement Program and in committees, task forces, and projects as appropriate. Contribute to a safe employee/patient environment and collaborate with all levels of the hospital interdisciplinary team. Demonstrate positive customer service and maintain professional relations and adherence to Customer Service Behavioral Standards. Support hospital initiatives and act as a positive change agent. Perform other related duties as assigned. Education & Experience Requirements
Minimum Education:
Graduate of an accredited college or university with a B.S. in Business or Health Administration required. Minimum Experience: Minimum of 2 to 4 years in Patient Accounting, preferably in a hospital setting. 3 years of demonstrated strong analytical skills with knowledge of patient accounting, third-party contracting, and/or contract modeling systems or healthcare reimbursement. Proficiency with Microsoft Office/Excel to include reporting, with executive-level proficiency preferred. Core Competencies
Proficient in Excel and in preparing reports and presentations. Strong analytical and troubleshooting skills. Knowledge of hospital billing and reimbursement, including third-party billing. Ability to understand payment methodology and apply formulas. In-depth knowledge of the complete healthcare revenue cycle. Experience/knowledge of contract language and payment methodology. Strong communication skills. Ensures compliance with state regulations and accreditation standards. Uses multiple methodologies to communicate information. Maintains knowledge of revenue cycle principles, practices, procedures, regulatory compliance, and internal controls. Submits required work reports to the Division Administrator as requested. Keeps leadership informed of the status of third-party plan payments and analysis progress. Maintains integrity and composure under stress. Physical / Mental Demands / Work Environment
May be exposed to chemicals; SDS information is available on the hospital intranet and switchboard. May remain in a stationary position for 50% of the time. Occasional walking within the office to access file cabinets and equipment. Continuous use of a computer and office equipment; frequent communication with patients and insurers requiring accurate information exchange. Must be able to greet patients. Primary Population Served
Infant (29 days – less than 1 year) Patients with developmental delays Pediatric (1 – 12 years) Patients at end of life Adolescent (13 – 17 years) Patients under isolation precautions Adult (18 – 64 years) Patients with cultural needs Geriatric (65 years and older) All populations Bariatric Patients with weight related comorbidities Non-patient care population The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.
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Managed Care Analyst The Managed Care Analyst is responsible for analytics, reporting, trending, and validation of reimbursement from third party plans in relation to the hospital's negotiated fees and adherence to contract terms. The role includes testing and maintenance of contract software, host system contract builds, and fee schedule loading. The Analyst prepares reports on contractual variances and payer issues for leadership and collaborates with the Managed Care Contracting team to resolve discrepancies. The position also maintains relations with payer representatives and oversees the provider escalation process and file maintenance. Responsibilities
Understands and adheres to the WPH Performance Standards, Policies and behaviors. Support special projects by collecting, analyzing, and modeling claim data in preparation for payer contract negotiations at least four months in advance of contract renewal. Analyze reimbursement using rates based on contract structure. Assist in testing and maintenance of contracts, including fee schedules in the host system and contract software tools. Assist with testing of contracts to confirm methodology, including matching current contract terms and rates. Assist in preparing a contract reference guide and summary of terms for loading and distribution to the revenue cycle team. Perform audits and reconciliation of plan payments to contract terms, identify variances, and communicate issues to leadership and the Managed Care team. Collaborate with third-party payers to rectify contract discrepancies identified through payment audits. Prepare and maintain provider representative escalation files. Take meeting minutes and provide updates to leadership on provider representative JOC calls. Assist with data preparation and terms for contract modeling. Assist with quality measurement of contract modeling application for accuracy. Maintain knowledge of state and federal regulations, monitor payer policy changes, and communicate updates to HQ staff as appropriate. Conduct revenue cycle analysis, trend analysis, prepare month-end reports, and assess plan contract performance and progress. Provide analysis, reporting, and recommendations for plan-specific contracts and future negotiations to Senior Management and the Managed Care Team. Assist with audits of plan payments and denials to ensure adherence to contract terms and escalate findings as needed. Maintain knowledge of third-party reimbursement policies and practices. Track, trend, and report on initiatives and projects to senior leadership. Ensure compliance with hospital and Human Resources policies and that competency and education requirements are satisfied as per policy. Participate in the Performance Improvement Program and in committees, task forces, and projects as appropriate. Contribute to a safe employee/patient environment and collaborate with all levels of the hospital interdisciplinary team. Demonstrate positive customer service and maintain professional relations and adherence to Customer Service Behavioral Standards. Support hospital initiatives and act as a positive change agent. Perform other related duties as assigned. Education & Experience Requirements
Minimum Education:
Graduate of an accredited college or university with a B.S. in Business or Health Administration required. Minimum Experience: Minimum of 2 to 4 years in Patient Accounting, preferably in a hospital setting. 3 years of demonstrated strong analytical skills with knowledge of patient accounting, third-party contracting, and/or contract modeling systems or healthcare reimbursement. Proficiency with Microsoft Office/Excel to include reporting, with executive-level proficiency preferred. Core Competencies
Proficient in Excel and in preparing reports and presentations. Strong analytical and troubleshooting skills. Knowledge of hospital billing and reimbursement, including third-party billing. Ability to understand payment methodology and apply formulas. In-depth knowledge of the complete healthcare revenue cycle. Experience/knowledge of contract language and payment methodology. Strong communication skills. Ensures compliance with state regulations and accreditation standards. Uses multiple methodologies to communicate information. Maintains knowledge of revenue cycle principles, practices, procedures, regulatory compliance, and internal controls. Submits required work reports to the Division Administrator as requested. Keeps leadership informed of the status of third-party plan payments and analysis progress. Maintains integrity and composure under stress. Physical / Mental Demands / Work Environment
May be exposed to chemicals; SDS information is available on the hospital intranet and switchboard. May remain in a stationary position for 50% of the time. Occasional walking within the office to access file cabinets and equipment. Continuous use of a computer and office equipment; frequent communication with patients and insurers requiring accurate information exchange. Must be able to greet patients. Primary Population Served
Infant (29 days – less than 1 year) Patients with developmental delays Pediatric (1 – 12 years) Patients at end of life Adolescent (13 – 17 years) Patients under isolation precautions Adult (18 – 64 years) Patients with cultural needs Geriatric (65 years and older) All populations Bariatric Patients with weight related comorbidities Non-patient care population The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.
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