What are the responsibilities and job description for the Managed Care Analyst position at NemoursCareerSite?
Nemours Children’s Hospital, Florida is seeking a Managed Care Analyst (Remote) (FULL-TIME), to join our team.
The Managed Care Analyst will:
- This position provides analytical support to Nemours departments in such areas as Nemours Business Operations, Administration, Strategic Planning, Finance, both Practice and Facility, and other areas across the enterprise.
- This position will construct and manipulate large databases to produce reports necessary for contract negotiations (including but not limited to: fee-for-service, value-based reimbursement, per diem, DRG, and % of Charge agreements), acquisitions, annual budgeting, price transparency, payor audits, and payor performance.
- Performs audits of existing contracts to ensure our internal processes and systems, as well as the contracted organization are all in compliance with executed contracts; provides detailed analysis of all results including full impact on finances and internal processes, of non-compliance and developments that potentially impact contract compliance.
- Prepares contract financial analysis for acquirement, negotiation and/or termination of contracts.
- Provide reports that summarize findings and provides recommendations to Management of all analyses performed, routine or otherwise.
- Reviews the different types of fees and its application to different location and insurance classifications; comparison between commercial and government payer, utilization of different codes and updates on national fee schedules.
- Performs routine, and ad-hoc financial reporting for other groups within Managed Care and outside departments. Providing analysis, findings and/or recommendations as requested.
- Develops and maintains reporting tools related to reports and databases used within the Managed Care Department.
- Perform other duties as required
Qualified Candidates will:
- Baccalaureate (up to 3-4 years of formal training/education beyond high school, e.g., Bachelor's Degree) required.
- Minimum 3 years of experience.
- Knowledge of EPIC, Crystal & Qlickview a plus.
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