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Managed Care Analyst (Remote)

Company: Johns Hopkins HealthCare
Location: Saint Petersburg
Posted on: September 16, 2023

Job Description:

At Johns Hopkins All Children's Hospital we offer an excellent Benefits Package, to include:

  • Affordable healthcare
  • Paid Time Off (PTO) and company paid holidays
  • Tuition Assistance
  • Life and disability insurance
  • Opportunities for career development
  • Employee discount program - travel, tickets, dining and more! Position Summary:

    The Managed Care Analyst is responsible for all loading, modeling, support, and maintenance of the managed care contracts and fee schedules within the contract management system. This includes contracts for all Health Systems entities; facility, professional, home care, infusion, pharmacy, etc. Provides key support for the implentation of new and upgraded systems/releases or new/revised operational procedures. Is capability to model, support and operationalize risk-based contracting methodologies and global transplant agreements is also necessary.

    Key Accountabilities:
    • Responsible for accurately loading and maintaining all fee schedule and contract terms into the contract management system to maintain patient care and billing integrity
    • Assists with the resolution of payment discrepancies, and thoroughly tests and validates loaded contracts to effectively maximize both patient care and revenue cycle needs
    • Completes the prospective modeling of proposed contracts, scenarios, and other changes potentially impacting reimbursement to support day to day operations and contract negotiations
    • Proactively or upon request reviews contract performance, identifies improvement opportunities, and models impact for Managed Care review to inspire ehanced continuous improvement
    • Generates periodic (monthly, quarterly, etc.) standard reports and surveys in accordance with the established schedule to stay abreast of market trend
    • Analyzes, compares and determines the financial impact of Medicare/Medicaid/ TriCare and commercial fee schedule changes and utilize the data to develop "what-if" scenarios to support managed care contract negotiations Work Hours: 8am - 4:40pm

      Work Location: Remote

      (must reside in Maryland, Virginia, Washington DC, Pennsylvania, Florida or Delaware)

      • Bachelor's degree in Business, Accounting, Finance, Health Care Management or associated field of study
      • Licensure/Certification: Required to complete training and become certified in these EPIC application modules - Resolute Hospital Billing Expected Reimbursement Contracts Administration, Resolute Professional Billing Reimbursement Contracts
      • 3 years experience working in a decision support or financial analysis position with responsibility in a managed care healthcare provider environment
      • Computer skills with proficient knowledge of spreadsheet/graphics software, presentation software, database software, and report writer software
      • Possesses a working knowledge and understanding of managed health care contracts and have experience with contract modeling and contract management systems
      • Possesses strong financial analysis skills and project management skills

        We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Hospital has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts - including while at lunch or on breaks, and whether they are on or off campus.

        Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law. Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Keywords: Johns Hopkins HealthCare, St. Petersburg , Managed Care Analyst (Remote), Professions , Saint Petersburg, Florida

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