Managed Care Contracting Analyst

Jobtailor; Deutschland; Remote; EUR 55.000 - 75.000; Vollzeit

Zusammenfassung

Jobtailor in Germany is seeking a healthcare analytics professional to analyze financial and operational performance of healthcare contracts, with emphasis on Medicaid and managed care products. You will create models, perform data extraction, and report findings to leadership while coordinating with Revenue Cycle and health plans.

Strong analytic and communication skills are essential for timely, accurate insights.

Qualifikationen

• High school graduate or equivalent.
• Bachelor’s Degree in Finance or Healthcare Administration preferred.
• Minimum of three years’ experience in an analytic or analyst role in a healthcare environment.
• In-depth knowledge of physician reimbursement.
• Two or more years’ experience with Revenue Cycle Billing.
• Experience using relational databases, decision support systems, analysis and modeling.
• Knowledge of the payor reimbursement process.
• Knowledge of computer systems.
• Knowledge of Health Plan Billing claim paperwork and timelines.
• Knowledge of Health Plan Billing timelines and regulations.
• Ability to establish good working relationships with internal and external customers.
• Ability to communicate effectively with staff, leadership, health plan representatives, and other departments.
• Ability to organize and efficiently manage daily work activities/projects.
• Ability to exercise independent judgment and decision-making.
• Ability to meet demanding deadlines.
• CORE Creed must be read and signed.
• OSHA requirements and training, including safety training.

Aufgaben

• Prepare analyses of the financial and operational performance of healthcare contracts, including regulatory rate and other changes.
• Identify performance issues and recommend areas for improvement.
• Analyze Medicaid and other managed care products, including HMO, PPO, and POS products.
• Monitor and trend third-party reimbursement, including denial analysis.
• Create financial models and reports for existing and new reporting needs.
• Support management by locating data sources and collecting data under tight time constraints.
• Identify and analyze utilization patterns driving healthcare costs and recommend actions to improve financial performance.
• Review shared-risk claims, capitation, risk-pool settlements, and health-plan reports.
• Submit shared-risk discrepancy reports within required timelines and formats.
• Create payor reimbursement reports for senior leadership.
• Recommend changes in application utilization to Revenue Cycle.
• Create queries to extract financial and claims data for analytical and statistical models.
• Identify and communicate trends and potential issues to management.
• Serve as liaison between health plans and Revenue Cycle.
• Collaborate with Contracting/Credentialing to optimize health payor reimbursement.
• Analyze health payor optimization within each market.
• Create and schedule JOCs with applicable health-plan representatives.
• Update and audit the Clearwave system to keep provider information current.
• Extract and query data from multiple sources and systems, compiling written and verbal reports and presentations.

Kenntnisse

Financial Analysis

Healthcare Contract Performance

Revenue Cycle Billing

Data Extraction

Payor Reimbursement Process

Ausbildung

High school diploma or equivalent

Bachelor’s Degree in Finance or Healthcare Administration

Tools

Clearwave System

Analytical Software

Reporting Tools

Database Management Systems

Jobbeschreibung

• Prepare analyses of the financial and operational performance of healthcare contracts, including regulatory rate and other changes
• Identify performance issues and recommend areas for improvement
• Analyze Medicaid and other managed care products, including HMO, PPO, and POS products
• Monitor and trend third-party reimbursement, including denial analysis
• Create financial models and reports for existing and new reporting needs
• Support management by locating data sources and collecting data under tight time constraints
• Identify and analyze utilization patterns driving healthcare costs and recommend actions to improve financial performance
• Review shared-risk claims, capitation, risk-pool settlements, and health-plan reports
• Submit shared-risk discrepancy reports within required timelines and formats
• Create payor reimbursement reports for senior leadership
• Recommend changes in application utilization to Revenue Cycle
• Create queries to extract financial and claims data for analytical and statistical models
• Identify and communicate trends and potential issues to management
• Serve as liaison between health plans and Revenue Cycle
• Collaborate with Contracting/Credentialing to optimize health payor reimbursement
• Analyze health payor optimization within each market
• Create and schedule JOCs with applicable health-plan representatives
• Update and audit the Clearwave system to keep provider information current
• Extract and query data from multiple sources and systems, compiling written and verbal reports and presentations

Requirements

• High school graduate or equivalent
• Bachelor’s Degree in Finance or Healthcare Administration preferred
• Minimum of three years’ experience working in an analytic or analyst role in a healthcare environment
• In-depth knowledge of physician reimbursement
• Two or more years’ experience with Revenue Cycle Billing
• Experience using relational databases, decision support systems, analysis and modeling
• Knowledge of the payor reimbursement process
• Knowledge of computer systems
• Knowledge of Health Plan Billing claim paperwork and timelines
• Knowledge of Health Plan Billing timelines and regulations
• Ability to establish good working relationships with internal and external customers
• Ability to communicate effectively with staff, leadership, health plan representatives, and other departments
• Ability to organize and efficiently manage daily work activities/projects
• Ability to exercise independent judgment and decision-making
• Ability to meet demanding deadlines
• CORE Creed must be read and signed
• OSHA requirements and training, including safety training

Core Competencies

Demonstrates expertise in financial analysis and operational performance within healthcare contracts, with a strong focus on Medicaid and managed care products. Proficient in data extraction, reporting, and communication with stakeholders to optimize reimbursement processes.

Highest-signal resume keywords

• Financial Analysis
• Healthcare Contract Performance
• Revenue Cycle Billing
• Data Extraction and Reporting
• Payor Reimbursement Process

ATS Optimization Keywords

Hard Skills

• Financial Modeling
• Data Analysis
• Utilization Pattern Analysis
• Claims Data Querying

  Soft Skills

  • Effective Communication
  • Relationship Building
  • Organizational Skills
  • Independent Judgment
  • Deadline Management

  Certifications & Qualifications

  • CORE Creed
  • OSHA Training

  Industry Keywords

  • Healthcare Administration
  • Medicaid
  • HMO
  • PPO
  • POS
  • Third-Party Reimbursement
  • Capitation
  • Risk-Pool Settlements
  • Health Plan Regulations
  • Performance Improvement

  Tools & Technologies

  • Clearwave System
  • Analytical Software
  • Reporting Tools
  • Database Management Systems