Managed Care Analyst

EvergreenHealth
Kirkland, WA Full Time
POSTED ON 10/17/2023 CLOSED ON 10/26/2023

What are the responsibilities and job description for the Managed Care Analyst position at EvergreenHealth?

Wage Range: $68,764 - $110,032 per year

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications, or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

This position can workHybrid remote/in-office.

Job Summary

Responsible for coordinating and completing the data reporting and analytical needs for the Contracts Management Department. Provides complex, advanced evaluation of proposed and contracted payer rates by utilizing Epic reporting, 3M coding grouper software, Alliance Decision Support (ADS) system and other analytical tools including Microsoft Access and Excel, as needed. Directly supports department leadership in all payer and health plan contract negotiations for all EvergreenHealths divisions (both hospitals, medical group, home care/hospice, ambulatory surgery center) through detailed scenario modeling, comparative analysis, and benchmarking. Assists in the monitoring of contract performance in Epic and Alliance Decision Support, tracks key contract statistics for regular, periodic reporting, completes ad hoc analysis to support business needs, and provides primary assistance in the development of specific contracting strategies.

Primary Duties

  1. Understands and interprets contract terms, reimbursement schedules, patient accounting system(s) and other sources of data to complete analyses and financial projections.
  2. Builds complex data models used for contract rate negotiations with payers.
  3. Summarizes impact of proposals for department leadership and provides detailed analysis if necessary.
  4. Develops and completes specialized statistical and financial analysis reports on payer volumes, payments, contractual adjustments, administrative fees, etc.
  5. Assists other team members as needed for maintenance of contract terms in Epic.
  6. Facilitates maintenance of necessary grouper software/systems as applicable for the various EvergreenHealth entities, types of billed claims and patient-types.
  7. Completes ad hoc reporting as needed, e.g., pro forma, new business development, etc.
  8. Tracks various value-based care (VBC) contract payments, including shared-savings, incentives, and capitation.
  9. Completes reconciliation reporting validation as needed for VBC contracts.
  10. Collaborates with finance team and participates in the annual budgeting process, as it relates to system revenue changes.
  11. Participates in the development of the contract negotiation strategy including various reference reports, benchmarking parameters, etc.
  12. Prepares summary narrative reports, graphs, tables, charts, and illustrations.
  13. Assists with implementation of new contracts and reporting.
  14. Assists in data collection for the completion of necessary payer credentialing applications for EvergreenHealth.
  15. Performs other duties as assigned.

License, Certification, Education or Experience:

REQUIREDfor the position:

  • Bachelors degree in finance, business, or health administration
  • Experience with patient accounting and claims billing and associated codes
  • Complex business modeling, statistical and trending skills
  • Proven experience in financial/business analysis
  • Experience with Alliance Decision Support system or equivalent

DESIREDfor the position:

  • Masters degree (MBA or MHA)
  • Minimum of 5 years of experience with health care, financial analysis and/or managed care contracts
  • Experience with health insurance operations and payment methodologies

Benefit Information:
Choices that care for you and your family

At EvergreenHealth, we appreciate our employees commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

  • Medical, vision and dental insurance
  • On-demand virtual health care
  • Health Savings Account
  • Flexible Spending Account
  • Life and disability insurance
  • Retirement plans (457(b) and 401(a) with employer contribution)
  • Tuition assistance for undergraduate and graduate degrees
  • Federal Public Service Loan Forgiveness program
  • Paid Time Off/Vacation
  • Extended Illness Bank/Sick Leave
  • Paid holidays
  • Voluntary hospital indemnity insurance
  • Voluntary identity theft protection
  • Voluntary legal insurance
  • Pay in lieu of benefits premium program
  • Free parking
  • Commuter benefits

View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.


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Salary : $68,764 - $110,032

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