Managed Care Analyst IV - Sutter Health
Sacramento, CA
About the Job
We are so glad you are interested in joining Sutter Health!
Organization:
SHSO-Sutter Health System Office-Valley
Position Overview:
Provides analysis and research to support the payer contracting process and ongoing contract relationship, including payer contract compliance efforts, for all Sutter Health affiliates and/or associates, including hospitals (acute, skilled nursing facilities, psychiatric and rehabilitation), surgical centers, ancillary services (home health and pharmacy), medical foundations, and Independent Physicians Association (IPAs). This involves requesting and reviewing claims files from vendors and providers and ensuring accuracy and trend issue identification for articulation and resolution in payer discussions. Also includes analysis as to root cause of issues and identification of opportunities for improvement. Interacts with local and corporate leadership, other management support staff, third party payer staff, inside and external legal counsel.
This is a hybrid role with both work from home and onsite opportunities.
Job Description :
EDUCATION:
_Equivalent experience will be accepted in lieu of the required degree or diploma._
+ Bachelor's: Accounting, Economics, Finance or other related field
TYPICAL EXPERIENCE:
+ 8 years recent relevant experience
SKILLS AND KNOWLEDGE:
+ Must be knowledgeable and thoroughly understand the various commercial third party payers, Medicare and Medi-Cal reimbursement requirements as it relates to acute hospitals, psychiatric hospitals, rehabilitation units, skilled nursing facilities, facility-based outpatient services, home health and professional services.
+ Must be knowledgeable and thoroughly understand commercial fee for service and risk arrangements (includes cap and sub-cap) for the applicable entities above in order to effectively integrate available utilization, financial and other data to develop financial analysis, revenue projection and modeling.
+ Must have thorough knowledge of the hospital accounting systems and audit processes in order to assess payer performance.
+ Must be very knowledgeable in the use of personal computer and its applications, such as: spreadsheet, databases such as Access, and word-processing. SQL knowledge is preferred.
+ Must be knowledgeable in creating and developing work papers with supporting documents to establish audit trails to support analysis / models.
+ Must know and understand how to apply statistical methods.
+ Must be able to perform and complete work assignments effectively and accurately with very minimal direction and supervision.
+ Must have organizational, analytical and planning skills.
+ Must have ability to determine reasonableness of data acquired from various sources.
+ Must have written, verbal communication skills, and interpersonal and presentation skills.
+ Must be able to work with all levels of management and translate complex rules and regulation issues, requirements to non-reimbursement staff at the facility level.
Job Shift:
Days
Schedule:
Full Time
Shift Hours:
8
Days of the Week:
Monday - Friday
Weekend Requirements:
Occasionally
Benefits:
Yes
Unions:
No
Position Status:
Exempt
Weekly Hours:
40
Employee Status:
Regular
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $53.59 to $80.39 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._ __
Organization:
SHSO-Sutter Health System Office-Valley
Position Overview:
Provides analysis and research to support the payer contracting process and ongoing contract relationship, including payer contract compliance efforts, for all Sutter Health affiliates and/or associates, including hospitals (acute, skilled nursing facilities, psychiatric and rehabilitation), surgical centers, ancillary services (home health and pharmacy), medical foundations, and Independent Physicians Association (IPAs). This involves requesting and reviewing claims files from vendors and providers and ensuring accuracy and trend issue identification for articulation and resolution in payer discussions. Also includes analysis as to root cause of issues and identification of opportunities for improvement. Interacts with local and corporate leadership, other management support staff, third party payer staff, inside and external legal counsel.
This is a hybrid role with both work from home and onsite opportunities.
Job Description :
EDUCATION:
_Equivalent experience will be accepted in lieu of the required degree or diploma._
+ Bachelor's: Accounting, Economics, Finance or other related field
TYPICAL EXPERIENCE:
+ 8 years recent relevant experience
SKILLS AND KNOWLEDGE:
+ Must be knowledgeable and thoroughly understand the various commercial third party payers, Medicare and Medi-Cal reimbursement requirements as it relates to acute hospitals, psychiatric hospitals, rehabilitation units, skilled nursing facilities, facility-based outpatient services, home health and professional services.
+ Must be knowledgeable and thoroughly understand commercial fee for service and risk arrangements (includes cap and sub-cap) for the applicable entities above in order to effectively integrate available utilization, financial and other data to develop financial analysis, revenue projection and modeling.
+ Must have thorough knowledge of the hospital accounting systems and audit processes in order to assess payer performance.
+ Must be very knowledgeable in the use of personal computer and its applications, such as: spreadsheet, databases such as Access, and word-processing. SQL knowledge is preferred.
+ Must be knowledgeable in creating and developing work papers with supporting documents to establish audit trails to support analysis / models.
+ Must know and understand how to apply statistical methods.
+ Must be able to perform and complete work assignments effectively and accurately with very minimal direction and supervision.
+ Must have organizational, analytical and planning skills.
+ Must have ability to determine reasonableness of data acquired from various sources.
+ Must have written, verbal communication skills, and interpersonal and presentation skills.
+ Must be able to work with all levels of management and translate complex rules and regulation issues, requirements to non-reimbursement staff at the facility level.
Job Shift:
Days
Schedule:
Full Time
Shift Hours:
8
Days of the Week:
Monday - Friday
Weekend Requirements:
Occasionally
Benefits:
Yes
Unions:
No
Position Status:
Exempt
Weekly Hours:
40
Employee Status:
Regular
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $53.59 to $80.39 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._ __
Source : Sutter Health
