Sr. Managed Care Contract & Reimbursement Analyst
|Job Title||Category||Location||Job Type||Posted|
|Sr. Managed Care Contract & Reimbursement Analyst||Accounting/Finance/Billing||Miami, Florida 33131||Full-Time||07-01-2019|
Why VITAS Healthcare and What Do They Offer Me?
VITAS Healthcare is the nation’s leading provider of end of life care. We provide our employees opportunities for professional growth, advancement and competitive benefits.
Responsible for monitoring and analyzing reimbursement from third-party carriers as defined in contractual and federal or state agreements. Responsibilities include data analysis, financial interpretation of contract terms, contract modeling, financial analysis, data validation, developing reimbursement methodologies, maintaining contracts and identifying revenue enhancing opportunities. Develops alternative financial proposals based on analysis and modeling of contract performance by developing and preparing revised models using sound rationale, and present recommendations to VITAS senior leadership. Support the organization by providing ad-hoc detailed data reports related to Managed Care agreements and Patient Financial Services activity to internal and external customers.
- Complete financial impact analysis of contract negotiations, including modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of these proposals for future year(s) and developing alternative proposals within the budget parameters. Present analysis and recommendations to leadership.
- Prepare multiple analyses and presentations by extracting data from VITAS systems’ and relational databases utilizing expertise in Excel.
- Evaluate the need to create new or modify existing ad hoc and/or customized reports.
- Review setup for all new contracts/amendments and meeting with Revenue Cycle and Contract Services staff to ensure integrity of rates loaded.
- Stay abreast of all state and federal regulation changes that affect Fee Schedule pricing.
- Proactively model all changes to fee schedules to determine the financial impact on hospice revenue and communicate with leadership.
- Interpret managed care contract terms and validate understanding with the contract negotiator and model relevant parameters into contract model application.
- Actively participate in cross-functional teams to identify revenue enhancement opportunities and develop and implement solutions for under-performing program contracts, including improvements in denials and underpayments. Provide necessary reporting and analytics to support the goals of these teams.
- Perform analysis on managed care reimbursement to ensure compliance of contracted terms and to understand payment patterns of commercial and government Managed Care Organization (MCO) contracts
- Recommend contract provisions and protections to minimize payer policy impacts on VITAS revenue.
- Closely work with contract administration resources and keep open dialogue to ensure loaded contracts are accurate and updated as directed by management.
- Understand and apply federal and state requirements to ensure compliance with managed care programs as it relates to hospice services
- Conduct reviews of managed care information systems and data in accordance with protocols to objectively determine compliance with state and federal regulations and adherence to/alignment with industry standards and guidelines
- Effectively communicate review findings orally and in writing, including identification of strengths, best practices, and opportunities for improvement. Prepares tables, charts, graphs and technical summaries for presentation
- Conduct/assess appropriate sampling methodologies and conducts statistical significance
- Develop modeling process to benchmark reimbursement rates to Contracted Commercial and Managed Medicaid reimbursement levels
- Provide companywide assistance with managed care education and communication.
- Competitive compensation
- Health, dental, vision, life and disability insurance
- Pre-tax healthcare and dependent care flexible spending accounts
- Life insurance
- 401(k) plan with numerous investment options and generous company match
- Cancer and/or critical illness benefit
- Tuition Reimbursement
- Paid Time Off
- Employee Assistance Program
- Legal Insurance
- Roadside Assistance
- Affinity Program
- At least five years' experience in financial analysis, data mining and reporting required
- At least five years' experience in healthcare, contract modeling for facility or hospice agreements
- Knowledgeable on the conditions, current philosophies nationally recognized under the managed health and long-term care waiver programs, Medicaid eligibility and benefit policies, data systems and processes
- Ability to work on various assignments simultaneously
- Strong interpersonal skills within all levels of the organization
- Ability to navigate within automated systems and proficiency in Outlook, Word and Excel
- Bachelor’s degree in healthcare, management information systems (MIS), finance, statistics, mathematics or related field from an accredited college or university or the international equivalent required.