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Financial Analyst - Managed Care

Community Health Systems

United States

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About the role

Job Summary

Provides data retrieval / contract modeling / financial analysis support to Director, VP, and Managed Care Regional Contracting Directors.

Essential Duties and Responsibilities include the following.  Other duties may be assigned.  

  • Retrieves reimbursement data from hospital and physician accounting systems.
  • Builds financial models to analyze and evaluate the reimbursement impact of hospital and physician payer reimbursement methodology proposals 
  • Works with Managed Care Regional Contracting Directors on contract interpretation issues to ensure accuracy of contract models and financial analysis.
  • Produces clear and concise written reports summarizing payment modeling analysis. 
  • QA monthly data loads.
  • Completes special projects/reports as needed

Qualifications:

  • Well versed in reimbursement methodology including DRG, APC, COPPS, OPPS, Case Rates, Per Diems, HCPCS and CPT Code Fee Schedules (2-5 years’ experience). 
  • Familiar with hospital and physician billing and coding terminology including diagnostic codes, revenue codes, procedure codes, and HCPCS codes.
  • Well versed in healthcare product lines including HMO, PPO, HIX, Medicare, Medicaid, Tricare, Workers Comp. 
  • Must be able to clearly communicate complex and technical issues in writing and verbally.
  • Must have the ability to work independently and manage multiple projects simultaneously

Computer Skills: 

To perform this job successfully, an individual should have knowledge of 

  • Word Processing software
  • Exceptional skills in Excel. 
  • Knowledge of contract modeling systems such as FinThrive preferred. 
  • Knowledge of Access or SQL preferred.  

Education/Experience:

  • Bachelor’s degree required; emphasis in Accounting or Data Analytics preferred
  • 2-5 years’ work experience required
  • Prior experience in hospital, physician or health plan financial analysis, or equivalent experience preferred
  • Knows/has modeled/worked with health plan/hospital and physician managed care commercial and Medicare reimbursement methodologies and terminology