Managed Care Analyst - Nuvance Health

Description

Summary:

The Managed Care Analyst compiles, validates, and analyzes utilization and reimbursement data to aid in contract negotiations for all Nuvance entities. In addition to gathering volume data and modeling of current reimbursement, the Managed Care Analyst determines the need for methodology changes and proposes target rates benefiting the Nuvance Health System.  The position also compiles, validates, and analyzes utilization and reimbursement data to aid in contract negotiations for all Nuvance entities. 

Responsibilities:

1. Provides support for special projects which includes but is not limited to, collecting and analyzing claim data in preparation for payer contract negotiations, creating profit and loss analyses for each entity’s negotiations and ensuring accuracy of agreed upon terms. Facilitates contract finalization and implementation according to department process.          

2. Responsible for Single Case agreement negotiations and communication.          

3. Organizes and analyses physician practice reimbursement, utilizing appropriate rates based on contract structure, place of service, provider and modifiers for each CPT code.         

4. Responsible for contract modeling in the Decision Support Tools for all Nuvance Health entities, and assist in the rate build in the Patient Accounting Systems (Cerner for Hospitals and Physicians). Creates custom reports from Decision Support systems for all relevant payer plans to provide necessary volume, payment and cost data.  Validates accuracy of data.          

5. Calculates Medicare reimbursement and compares to payer reimbursement for same volume. Analyzes current reimbursement in relation to cost and identifies opportunities for improved reimbursement. Develops proposed and target rates considering profit margin in comparison to other services and other payers, payer denials and policies, payer market share, etc.       

6. Liaison between billing/managed care departments, the payer, Business Office, Practice Management and other affiliate billing departments. Serves as “Subject matter Experts” for all questions concerning assigned payers.          

7. Reviews written communication of payment, contract and negotiation documents to ensure appropriate content.  Collaborates with key stakeholders, i.e. Legal Counsel to modify payer’s standard language, as needed.    

8. Prepares, compiles and consolidates data for reporting to organizational leadership.     

Other Information:

• Ability to build financial and statistical models, analyze data, and translate analysis into specific, targeted action to drive results.
• Proficiency in working with complex and large volumes of data.
• Strong problem-solving skills.
• Ability to work in a fast paced and changing environment.
• Strong organizational and written/oral communication skills.
• Ability to work independently and with little supervision.
• Excellent ability to manage to deadlines.
• Professional attitude required in challenging conditions.

Working Conditions:

Manual: Some manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Nuvance Health

Org Unit: 1783

Department: Managed Care

Exempt: Yes

Salary Range: $27.91 - $40.00 - hourly - based off experience and internal equity