Responsible for analyzing the financial and operational performance of healthcare contracts, with a focus on managed care and reimbursement performance.
Key responsibilities include:
- Analyze financial and operational performance of healthcare contracts, including the impact of regulatory rate changes
- Provide analysis for Medicaid and managed care products such as HMO, PPO, and POS plans
- Monitor and trend third-party reimbursement, including denial analysis
- Create financial models, queries, reports, and statistical analyses
- Support management by collecting, locating, and presenting data under tight time constraints
- Identify utilization patterns affecting healthcare costs and recommend improvements
- Review shared risk claims, capitation, risk pool settlements, and health plan reports
- Serve as liaison between health plans and revenue cycle teams
- Collaborate with contracting and credentialing teams to optimize reimbursement outcomes
- Audit and update provider information in the Clearwave system
- Extract and compile data from multiple sources for written and verbal reporting
Requirements & Qualifications
Education and experience:
- High school diploma or equivalent required
- Bachelor's degree in Finance or Healthcare Administration preferred
- Minimum 3 years of experience in an analyst or analytical role within a healthcare environment
- In-depth knowledge of physician reimbursement
- At least 2 years of experience with revenue cycle billing
Knowledge and skills:
- Knowledge of payor reimbursement processes, health plan billing, and related timelines/regulations
- Experience using relational databases, decision support systems, analysis, and modeling tools
- Ability to establish effective working relationships with internal and external customers
- Strong organization, prioritization, and time management skills
- Ability to meet demanding deadlines
- Effective communication with staff, leadership, and health plan representatives
- Ability to work independently and exercise sound judgment
Location
Phoenix, Arizona, US
Employment Type
Not specified
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago