Managed Care Finance Specialist (RCM) Hybrid

Tenet Global Business Center, Inc.; Taguig; Vor Ort; PHP 700.000 - 1.200.000; Vollzeit

Zusammenfassung

Tenet Global Business Center, Inc. is seeking a Managed Care Finance Analyst/Sr. Analyst to interpret contract terms, load them into claims adjudication systems, and prepare complex analyses with high accuracy.

In this role you will act as SME/POC for Complex Contracts Management, support SOX 1 audits, and lead workload allocation with the supervisor, while training staff and ensuring adherence to procedures and regulations.

Qualifikationen

• Strong problem solving and analytical skills.
• Advanced Excel capabilities (Pivot tables, LOOKUP).
• Experience in healthcare or Managed Care is preferred.
• Ability to train and coach staff and lead teams.

Aufgaben

• Interpret and load Managed Care contract terms into claims systems.
• Prepare complex contract analyses with high accuracy.
• Act as SME/POC for Complex Contracts Management and escalation support.
• Support SOX 1 audit reviews and quarterly renewals.
• Lead workload allocation with supervision and ensure timely completion of tasks.
• Document and maintain processDocumentation; stay updated on policies and regulations.
• Identify opportunities to streamline and improve the contract loading process.

Kenntnisse

Problem solving

Analytical skills

Communication

Leadership

Training

Multitasking

Customer service

Teamwork

Ausbildung

Bachelor's Degree

Tools

Microsoft Excel

Jobbeschreibung

Job Description

• Review and accurately interpret Managed Care contract terms

• Load contract terms into various claims adjudication systems.

• Prepare complex contract analyses as requested with high degrees of accuracy and efficiency

• Act as overall SME/POC:

  Complex Contracts Management: Handle, research, and resolve escalated or complex contract loading issues, collaborating between claims pricing system and Business Office and Managed Care personnel for inquiry and resolution of related items including contract terms, contract performance and payment discrepancies

  Workload Allocation. Work with Supervisor on the day-to-day aspect of operation and leadership of Managed Care Finance Analyst/Sr. Analyst including but not limited to: Workload Allocation and Timely Completion of daily / weekly assignments.

  SOX 1 Audit Review Support. Act as primary support in performing SOX 1 (Peer-to-Peer) Audit Review during Quarterly Renewals and/or special project as may be deemed necessary (i.e PRCT contracts)

  Team Support: Train, guide and provide ongoing support to Managed Care Analysts and Sr, Analyst, ensuring quality and adherence to best practices

  Escalation Support: Act as secondary point of contact for both internal and external stakeholders

  Documentation, Policy and Procedure Adherence: Maintain up-to-date process documentation, and stay current with changing contract terms policies, regulations and departmental procedure

  Workflow Improvement: Work with the Managed Care Finance Supervisor to Identify opportunities to streamline and improve the Managed Care contract loading and maintenance process contributing to efficiency and customer satisfaction.

• Escalate any erroneous payment and identify trends and mitigate strategies to Managed Care Operations GBC/Onshore Leaders and Business Office Personnel

Required:

• Prior healthcare related financial analysis, preferably in Managed Care reimbursement.
• Strong Microsoft Excel knowledge (Pivot tables, LOOKUP formulas, etc).
• Knowledge of Google Cloud / Big Query preferred but not required.
• Strong problem solving and analytical skills.
• Familiarity with
  • Healthcare Reimbursement methodologies
  • Coding (DRG, APC, CPT/HCPCS, ICD-10)
  • UB04 and HCFA-1500 bill forms
• Ability to provide advanced customer service
• Ability to plan and implement process improvements
• Ability to train and coach staff
• Ability to multi-task
• Strong leadership and organizational skills
• Proficient in building a strong team to meet performance goals
• Very good written and verbal communication skills
• Strong interpersonal skills

Preferred:

• Exposure on Various Contract Review and Management, Insurance, Healthcare and Client Service
• Strong knowledge of various ambulatory centers setting business units includes Contracts Management and/or Managed Care Reimbursement or Financial Analysis

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience for the job.

Required:

• Bachelor's Degree
• 3-5 years of experience in the clerical or healthcare field/ Revenue Cycle Management/ Various Contract Review and Management
• 2-3 years supervisory experience or demonstrated leadership and capacity

Preferred:

• Various Contract Review and Management, health plan or Revenue Cycle Management experience
• Previous experience with ambulatory centers such Contracts Management and/or Managed Care Reimbursement or Financial Analysis
• Advanced knowledge of Managed Care Reimbursement or other healthcare methodologies