Managed Care Finance Analyst

This position is responsible for the loading & maintenance of Managed Care and other contract pricing terms into various contract management and claim pricing systems of Tenet and USPI entities. This person may also perform complex contract analyses. This person may also function as a liaison between the claims pricing system and Business Office and Managed Care personnel for inquiry and resolution of related items including contract terms, contract performance and payment discrepancies.

Key functions of this role include:

• Review and accurately interpret Managed Care contract terms.
• Load contract terms into various claims adjudication systems.
• Prepare complex contract analyses as requested with high degrees of accuracy and efficiency.
• Works closely with Managed Care Operations team to ensure timely and accurate contract implementation and maintenance.
• Work closely with Managed Care and Business Office personnel in identifying erroneous payment trends and mitigation strategies.

Qualifications:

• Bachelor’s degree is required.
• Prior healthcare related financial analysis, preferably in Managed Care reimbursement.
• Strong Microsoft Excel knowledge (pivot tables, LOOKUP formulas, etc).
• Knowledge of Google Cloud / Big Query preferred but not required.
• Strong problem solving and analytical skills.
• Familiarity with
• healthcare reimbursement methodologies
• coding (DRG, APC, CPT/HCPCS, ICD-10)
• UB04 and HCFA-1500 bill forms
• Demonstrates a high level of critical thinking.
• Strong organizational skills, including project planning and time management.
• Communicates effectively both verbally and in writing.