Contract and Data Analyst (Managed Care)

Saint Francis Hospital, Inc.; New Haven (CT); On-site; USD 70,000 - 95,000; Full time

Job summary

Saint Francis Hospital seeks a Contract Analyst to analyze and negotiate health plan contracts, developing EPIC-based models to support favorable outcomes for the system.

The role requires at least a bachelor's in business or related field, Epic certification, and strong data analysis skills. 3–4 years' experience in contract negotiations and knowledge of Access, Excel, and Word are preferred. On-site work at Yale Campus Location in Tulsa, OK is expected.

Qualifications

• Bachelor's degree in business or related field required.
• Epic certification and experience with health plan contracting preferred.
• Experience with data analysis and financial modeling for contracts.

Responsibilities

• Analyze contracts and communicate operational impact to health system contacts.
• Develop, monitor, and analyze financial performance of contracts.
• Negotiate with payors and ensure contract compliance and revenue integrity.
• Create data sets and maintain contract analysis processes.
• Collaborate with Epic team to develop and test contract projection models.

Skills

Epic Certification

Independent Work

Time Management

Analytical Thinking

Excel

Word

Access

Communication

Education

Bachelor's Degree in Business or related field

Tools

EPIC

Microsoft Access

Job description

Job Summary

Full Time Days Please note: This position is located at the Yale Campus in Tulsa, OK, and does not offer remote work options. Qualified candidates must be available and willing to work onsite. Schedule: Monday - Friday | 8:00am - 5:00pm Job Summary: Responsible for analysis of contracts and performing contract negotiations to include monitoring and reviewing existing contracts to ensure payment compliance, communicating and resolving contract issues both internal and external to the organization, and contributing to health system and individual contract negotiation strategies. Develops and builds contract projections models (EPIC) essential to negotiation outcomes for the health system.

Minimum Education

Bachelor's Degree in Business or related field required.

Licensure, Registration and/or Certification

Obtain and maintain Epic certification in assigned application module(s).

Work Experience

3 - 4 years related experience. Experience with health plan insurance contracting and reimbursement for providers. Experience with Microsoft Access, data warehouse applications, contract negotiations, contract financial modeling, contract language interpretation and EPIC preferred.

Knowledge, Skills and Abilities

• Ability to complete Epic certification and maintain certification in assigned application module(s).
• Ability to work independently and within a team across multiple disciplines.
• Ability to establish and meet work schedules within limited time frames and under tight deadlines.
• Analytical ability to solve both business and technical problems.
• Working knowledge of Microsoft Excel, Word, and Access.
• Excellent interpersonal, written and oral communication skills.
• Ability to be detail oriented as required in the analysis and examination of complex information.

Essential Functions and Responsibilities

• Analyzes contracts and communicates operational impact of contracts to appropriate health system contacts.
• Develop models, analyzes, and monitors financial performance of existing and proposed contracts.
• Monitors contract performance and compliance to ensure contracts are performing at expected levels by auditing financials and negotiating with payors for money due if appropriate.
• Reviews and negotiates language in the contracting negotiation processes.
• Develops, produces, and maintains data sets required for contract analysis.
• Develops and maintains departmental processes to manage contracts.
• Resolves contractual disputes with payors by collaborating with various health system entities and all related parties.
• Responsible for the analysis, development, and testing of contract projection models within Epic essential to negotiation outcomes for the system for both physician and hospital contracts/reimbursement.
• Builds programing and performs on going analysis, which maintains the integrity of financial expectations of managed care contracts within the Epic system.
• Resolves programming issues related to rate and revenue codes operations through modification to yield maximum revenue potential for both physician and hospital contracts/reimbursement.
• Ensures through Epic testing that the build is developed and performing the collaborates with the Epic team to put into production and to enhance contract modeling within Epic.
• Performs other related duties as assigned to fulfill department responsibilities.

Decision Making

The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.

Working Relationships

Coordinates activities of others (does not supervise). Works with internal customers via telephone or face to face interaction. Works with external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.

Special Job Dimensions

None.

Supplemental Information

This document generally describes the essential functions of the job and the physical demands required to perform the job. This compilation of essential functions and physical demands is not all inclusive nor does it prohibit the assignment of additional duties.

Equality of Opportunity / Diversity Statement

EOE Protected Veterans/Disability Saint Francis is a Catholic, not-for-profit Health system based in Tulsa, Oklahoma.

Financial Services - Yale Campus Location

Tulsa, Oklahoma 74136

About the Organization

We are the largest private employer in Eastern Oklahoma with over 12,000 employees, including 1,000 physicians. The health system is anchored by the 1,112-bed Saint Francis Hospital, the largest hospital in Oklahoma and the 11th largest in the nation. Our system also includes hospitals in south Tulsa, Muskogee and Vinita, as well as 110 Warren Clinic locations from Monkey Island to McAlester, northeastern Oklahoma's only children's hospital, a level IV neonatal intensive care unit, a 168-bed heart hospital, and Tulsa's leading trauma and emergency center.