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PFS Managed Care Analyst

Company: Dignity Health
Location: Prescott
Posted on: November 27, 2022

Job Description:

OverviewCommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.ResponsibilitiesJob Summary / PurposeResponsible for contract management, project management and associated reporting to support internal/external customers and assure compliance with state, federal and other regulatory agency requirements.Essential Key Job Responsibilities -Contract Management, Reporting & Analysis

  • Maintains an understanding of the key elements of a payer contracts (commercial, Medicare advantage, Medicaid HMO), including reimbursement
  • Reviews contracts and makes recommendations to ensure standardization and consistency in payer
  • Performs audits to validate payer compliance with contracts by using various standard reports, data integrity testing and claim reconciliation payment Identifies opportunities and makes recommendations to renegotiate contacts, in order to maximize hospital reimbursement levels.
  • Performs quality control measures on contract processes, including system setup, claim adjudication and payment
  • Drafts contract documents and letters to
  • Models DRG reimbursement, CPT or UB Code based reimbursement and simple and complex
  • Updates all necessary elements of the reimbursement
  • Analyzes and researches account(s) for contract interpretation errors or incorrect payments and pursues additional payment if necessary.
  • Researches payor medical policies for coverage issues or for contract
  • Organizes and provides data support for all payor issues in anticipation of a payor
  • Leads payor meetings and ensures that all necessary documents/analysis are provided by
  • Researches new types of insurance product offerings through a variety of sources.
  • Obtains and analyzes the various filings by insurance companies to the department of
  • Prepares monthly variance
  • Reviews monthly contractuals to determine cause of any
  • Prepares the budget/forecast model for
  • Responsible for the Decision Support System generation and analysis of the following:
    • Detailed Patient Listings
    • Case Mix / Payor Mix
    • Expected vs Actual Payments
    • Data for use in and completion of Project Analysis
    • Budget Modeling
    • Net Revenue Modeling
      • Models all elements of contract for Revenue Cycle Processing
      • Responsible for maintaining a working knowledge of the following:
        • Collections and posting
        • Interaction between all aspects of the revenue
        • Interaction of the chargemaster, coding and expected
        • Takes full accountability for all work assigned including following up with others in the
        • Prepares 100% accurate analysis for any assignment and presents in executive ready Project Management
          • Responsible for the coordination and completion of Revenue Cycle projects, including, but not limited to, compliance issues, charge discrepancies, data integrity, and new service monitoring. Serves as the PFS department representative on projects that involve multiple department participationQualifications
            • Associate's degree in Business Administration or related field and five years of experience in a hospital or medical insurance business office setting; Bachelors degree preferred. An equivalent combination of education and/or experience may be
            • Experience working with managed care contracts, including contract negotiation and analysis preferred.
            • Thorough knowledge of PC based applications with intermediate experience in MS Word and Excel, including charts and
            • Knowledge of Google Suite is preferred.
            • Thorough knowledge and intermediate experience in database applications with a working knowledge of information systems
            • Electronic Medical Record (EMR) experience preferred; Cerner strongly preferred
            • Broad healthcare knowledge in all aspects of admitting, billing and
            • Experience in training and development
            • Excellent multi-tasking, analytical, organizational and problem-solving
            • Excellent interpersonal skills and the ability to effectively communicate verbally and in writing providing excellent customer
            • Must be able to adapt to change of duties quickly and smoothly.A compensation range of $20.71/hr and $25.89/hr is -the reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law. While youre busy impacting the healthcare industry, well take care of you with benefits that include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility and more! This is a remote position. #LI-DH#LI-REMOTE#LI-CSH#MissionCritical

Keywords: Dignity Health, Prescott , PFS Managed Care Analyst, Professions , Prescott, Arizona

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