SEP Summit Medical Group, Inc.
Analyst Managed Care
SEP Summit Medical Group, Inc., Durham, North Carolina, United States, 27703
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Job Type:
Regular Scheduled Hours:
40 Job Summary:
The overall goal of the Managed Care Dept. is to maximize system revenue from third-party Medicare, Medicaid, and Commercial payers. The Managed Care Analyst assists the VP, Managed Care in contract negotiation and administration. He/she is considered the subject matter expert on all contractual and financial terms of the relationships with the system’s payer partners. Demonstrate respect, dignity, kindness, and empathy in each encounter with all patients, families, visitors, and other employees regardless of cultural background. Job Description:
Assist the VP, Managed Care, in all contract negotiations to ensure revenue targets are met or exceeded while mitigating contracting and pricing risks. Maintain Health Plan Administrative Manuals, contract rate sheets, and contract files. Work with the Director, CDM, to ensure that the annual CDM update process is modeled to produce the desired net effect on annual revenue. Assist with operationalizing contracts, training operational staff, and producing contract non-compliance reports. Provide weekly, monthly, and quarterly reports, including variance trend reports highlighting negative payment trends from third-party payers. Collaborate with Patient Financial Services to resolve billing errors promptly to ensure accurate reimbursement. Work with the Director of Patient Financial Services to target a payment accuracy rate of 90% or higher. Perform other duties as assigned. Education, Credentials, Licenses:
Bachelor’s degree in finance, accounting, or industry experience dealing with third-party payers is required. Specialized Knowledge:
Proficiency in Microsoft Office Suite (Word, Excel, Access) Understanding of third-party contractual relationships Experience:
Minimum of 3 years’ experience including general accounting, financial analysis, hospital billing, registration systems, and strong communication skills. FLSA Status:
Exempt Right Career. Right Here. If you're seeking a rewarding career in healthcare, join us at St. Elizabeth, where you'll take pride in the level of care we provide to our community. About Us
St. Elizabeth Healthcare is one of the oldest, largest, and most respected medical providers in the Northern Kentucky, Southeastern Indiana, and Greater Cincinnati region. Alongside St. Elizabeth Physicians, our multi-specialty physician and advanced practice provider organization, we are transforming healthcare through innovative treatments, cutting-edge technology, and a commitment to our community. We share one mission: to improve the health of the people we serve.
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Regular Scheduled Hours:
40 Job Summary:
The overall goal of the Managed Care Dept. is to maximize system revenue from third-party Medicare, Medicaid, and Commercial payers. The Managed Care Analyst assists the VP, Managed Care in contract negotiation and administration. He/she is considered the subject matter expert on all contractual and financial terms of the relationships with the system’s payer partners. Demonstrate respect, dignity, kindness, and empathy in each encounter with all patients, families, visitors, and other employees regardless of cultural background. Job Description:
Assist the VP, Managed Care, in all contract negotiations to ensure revenue targets are met or exceeded while mitigating contracting and pricing risks. Maintain Health Plan Administrative Manuals, contract rate sheets, and contract files. Work with the Director, CDM, to ensure that the annual CDM update process is modeled to produce the desired net effect on annual revenue. Assist with operationalizing contracts, training operational staff, and producing contract non-compliance reports. Provide weekly, monthly, and quarterly reports, including variance trend reports highlighting negative payment trends from third-party payers. Collaborate with Patient Financial Services to resolve billing errors promptly to ensure accurate reimbursement. Work with the Director of Patient Financial Services to target a payment accuracy rate of 90% or higher. Perform other duties as assigned. Education, Credentials, Licenses:
Bachelor’s degree in finance, accounting, or industry experience dealing with third-party payers is required. Specialized Knowledge:
Proficiency in Microsoft Office Suite (Word, Excel, Access) Understanding of third-party contractual relationships Experience:
Minimum of 3 years’ experience including general accounting, financial analysis, hospital billing, registration systems, and strong communication skills. FLSA Status:
Exempt Right Career. Right Here. If you're seeking a rewarding career in healthcare, join us at St. Elizabeth, where you'll take pride in the level of care we provide to our community. About Us
St. Elizabeth Healthcare is one of the oldest, largest, and most respected medical providers in the Northern Kentucky, Southeastern Indiana, and Greater Cincinnati region. Alongside St. Elizabeth Physicians, our multi-specialty physician and advanced practice provider organization, we are transforming healthcare through innovative treatments, cutting-edge technology, and a commitment to our community. We share one mission: to improve the health of the people we serve.
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