At Bristol Health, we begin each day caring today for your tomorrow. We have been an integral part of our community for the past 100 years. We are dedicated to providing the best possible care and service to our patients, residents, and families. We are committed to providing compassionate, quality care at all times and to uphold our values of Communication, Accountability, Respect, and Empathy (C.A.R.E.). We are Magnet and received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID-19 pandemic. Use your expertise, compassion, and kindness to transform the patient experience. Make a difference. Make Bristol Health your choice.
Job Summary:
Under the direction of the System Director, Managed Care, the Senior Analyst, Managed Care is responsible for the implementation, maintenance, reporting, and analysis in the contract modeling system of hospital services and third-party payor contracts including fee-for-service, value-based, and risk arrangements. The role also provides support to other entities of Bristol Health including an employed physician and urgent care group, home care and hospice agency, skilled nursing facility, and an EMS service. Also responsible for the maintenance and reporting of contract terms, as well as preparation and reporting of contract performance. Monitors Third Party reimbursement according to contracted rates. Assists in negotiation and claim resolution with Third Party payors and financial reporting across the health system. The expectation is the candidate can perform functions independently.
Essential Job Responsibilities:
- Maintains and analyzes contract management system data, reporting and MediTech Proration.
- Working knowledge of Strata, including Contract Modeling and Decision Support, and MediTech BAR module, and any additional or successor systems preferred.
- Analyzes system data for accuracy and takes corrective action when needed.
- Maintains and updates contract term/reimbursement rate tables.
- Routinely verifies software application to ensure accuracy in calculations.
- Working with vendor, maintains, updates, and validates proration rules built in MediTech.
- From proration discrepancies identified by billers, identify why variances between proration rules and actual payment may exist, take any corrective action if issue with proration and provide direction to biller on how to proceed.
- Prepares and distributes reports to monitor reimbursement accuracy and in preparation for contract negotiation.
- Standard reports are produced and reviewed to identify payment discrepancies.
- Reports produced and reviewed to assist in contract negotiations.
- Reports verified for completeness and accuracy.
- Special reports are run as needed.
- Review Payor Policies for any that may have implications on any of the entities under Bristol Hospital & Health Care Group, summarize and distribute.
- Independently negotiate rates with payors, as delegated by the Director.
- Independently coordinates, verifies, and monitors Third Party payments.
- Identifies and verifies Third Party contractual payment discrepancies.
- Develops action plan and coordinates Third Party notification of such discrepancies with Business Office.
- Monitors on a regular basis to ensure payment.
- Reviews payor policy updates for potential impact.
- Contributes to departmental goals and efficient operation of department.
- Assists in Managed Care Reporting as needed (e.g., matrix).
- Assists in maintenance of managed care agreements in MediTract and other systems.
- Assists in providing decision support services.
Educational / Minimum Requirements:
Bachelors’ Degree with 3+ years related hospital experience or Associates’ Degree with 5+ years related hospital experience.
Must be competent in Microsoft Excel and Word.
Strata and Meditech experience preferred.
State/Federal Mandated Licensure or Certification Requirements:
None.
Bristol Hospital Mandated Educational Requirements:
General orientation at time of hire. Fire/Safety/Infection Control annually. Other programs as mandated by hospital.
Special Requirements:
Working knowledge of Excel is required. Ability to operate personal computers and understand software products, including spreadsheet applications.
Physical Requirements:
Extended sitting, together with occasional bending, reaching, and stooping. Prolonged visual requirement to prepare accounting reports and read PC screens. May include customer contact and telephone use.
Work Environment:
Normal office conditions with adequate lighting and ventilation. May include customer contact and telephone use.
Cognitive Requirements:
Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities from time to time, as needed.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Health insurance
Schedule:
Work Location: In person
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