Managed Care Business Analyst

NorthShore University HealthSystem; Arlington Heights (IL); On-site; USD 45,000 - 68,000; Full time

Benefits offered by this job

Medical benefits

Tuition Reimbursement

Free Parking

Wellness Program

Health Savings Account Options

Retirement options with company match

Job summary

Endeavor Health in Arlington Heights is seeking a Managed Care Business Analyst to serve as the primary operational liaison between contracted payor health plan representatives and our Revenue Cycle teams. You will collaborate daily with hospital and physician teams to resolve payor issues affecting timely reimbursement and ensure proactive communication with internal stakeholders and payors.

The role emphasizes building strong payor relationships, leading monthly Revenue Cycle–payor meetings,

Qualifications

• Bachelor's degree or equivalent work experience.
• Two or more years of relevant experience in managed care organization, consulting firm, hospital system and / or hospital.
• Four to eight years of relevant experience in a managed care organization, consulting firm, hospital system and / or hospital is preferred.
• Proficiency in data analysis required.
• Microsoft Office, advanced spreadsheet skills.
• Epic experience preferred.
• Excellent written and verbal communication skills.
• Previous revenue cycle experience.

Responsibilities

• Establishes strong collaborative relationships with payor representatives.
• Leads monthly meetings between Revenue Cycle teams and payor.
• Responds to daily communication from payor and Endeavor stakeholders regarding health plan related issues including claim denials, prior authorization concerns and patient access issues.
• Routinely engages with Payor representatives to facilitate collaborative resolution with Revenue Cycle teams.
• Supports system wide communication of health plan policies, procedures, and system participation in contracted products and plans.
• Updates and shares all tools/documents created by the Payor Relations team that are utilized by Revenue Cycle and Clinical Teams (examples: Pre Certification rules Plan/Product Participation).
• Researches and resolves operational issues resulting in nonpayment or denial of payment.
• Acts as the second level escalation point for payor related reimbursement and operational issues.
• Identifies, analyzes, and communicates key issues/trends. Effectively documents and communicates trended issues and concerns to leadership.
• Resolves complex or critical situations involving internal departments and external stakeholders/payors. Works with Revenue Cycle, IT, Utilization Management and Patient Access to implement any major administrative payor requirement that has a material financial impact.

Job description

Hourly Pay Range:

$32.60 - $48.90 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.

Position Highlights:

* Position: Managed Care Business Analyst

* Location: 3040 Salt Creek Arlington Heights

* Full Time/Part Time: Full Time

* Hours: Monday-Friday, 8:00am-4:30pm

Job Summary:

This position serves as the key operational contact between contracted payor health plan representatives and Endeavor Revenue Cycle teams. The Managed Care Business Analyst collaborates daily with hospital and physician Revenue Cycle teams, as well as Operational and Clinical Departments to identify and solve trended issues with payors which affect accurate and timely reimbursement. Collaboration, engagement, and on-going, professional pro-active communication with internal stakeholders and payors is essential for success in this role.

What you will do:

• Establishes strong collaborative relationships with payor representatives.

• Leads monthly meetings between Revenue Cycle teams and payor.

• Responds to daily communication from payor and Endeavor stakeholders regarding health plan related issues including claim denials, prior authorization concerns and patient access issues.

• Routinely engages with Payor representatives to facilitate collaborative resolution with Revenue Cycle teams.

• Supports system wide communication of health plan policies, procedures, and system participation in contracted products and plans.

• Updates and shares all tools/documents created by the Payor Relations team that are utilized by Revenue Cycle and Clinical Teams (examples: Pre Certification rules Plan/Product Participation).

• Researches and resolves operational issues resulting in nonpayment or denial of payment.

• Acts as the second level escalation point for payor related reimbursement and operational issues.

• Identifies, analyzes, and communicates key issues/trends. Effectively documents and communicates trended issues and concerns to leadership.

• Resolves complex or critical situations involving internal departments and external stakeholders/payors. Works with Revenue Cycle, IT, Utilization Management and Patient Access to implement any major administrative payor requirement that has a material financial impact.

What you will need:

• The minimum educational requirement is a bachelor's degree, or equivalent work experience.

• Two or more years of relevant and/or progressive experience in managed care organization, consulting firm, hospital system and / or hospital.

• Four to eight years of relevant experience in a managed care organization, consulting firm, hospital system and / or hospital is preferred.

• Proficiency in data analysis required

• Microsoft Office, advanced spreadsheet skills

• Epic experience preferred

• Excellent written and verbal communication skills

• Previous revenue cycle experience

Benefits:

* Career Pathways to Promote Professional Growth and Development

* Various Medical, Dental, Pet and Vision options

* Tuition Reimbursement

* Free Parking

* Wellness Program Savings Plan

* Health Savings Account Options

* Retirement Options with Company Match

* Paid Time Off and Holiday Pay

* Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor