- Communication Skills
- CPT Coding
Nuvance Health is a family of award-winning nonprofit hospitals and healthcare professionals in the Hudson Valley and western Connecticut. Nuvance Health combines highly skilled physicians, state-of-the-art facilities and technology, and compassionate caregivers dedicated to providing quality care across a variety of clinical areas, including Cardiovascular, Neurosciences, Oncology, Orthopedics, and Primary Care.
Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations. For more information about Nuvance Health, visit www.nuvancehealth.org.
Title: Managed Care Analyst
Reports To: Managed Care (Manager/Director)
Department: Managed Care
FLSA Status: Exempt
Purpose: The Managed Care Analyst compiles, validates, and analyzes healthcare cost, quality and utilization data to aid in contract negotiations for all HQ entities. In addition to gathering volume data and modeling of current reimbursement, the Managed Care Analyst determines the need for methodology changes and proposes target rates benefiting the Health Quest System.
Provides support for special projects which includes but is not limited to, collecting and analyzing claim data in preparation for payer contract negotiations, creating profit and loss analyses for each hospital negotiations and ensuring accuracy of agreed upon terms documentation for contract finalization and implementation.
Responsible for full cycle Single Case agreements negotiations and communication.
Organizes and analyses physician practice reimbursement, utilizing appropriate rates based on contract structure, place of service, provider and modifiers for each CPT code.
Creates custom reports from Decision Support systems for all relevant payer plans to provide necessary volume, payment and cost data. Validates accuracy of data.
Calculates Medicare reimbursement and compares to payer reimbursement for same volume.
Analyzes current reimbursement in relation to cost and identifies opportunities for improved reimbursement.
Develops proposed and target rates considering profit margin in comparison to other services and other payers, payer denials and policies, payer market share, etc.
Liaison between billing/managed care departments, the payer, Business Office, Practice Management and other affiliate billing departments.
Serves as “Subject matter Experts” for all questions concerning assigned payers.
Reviews written communication of payment, contract and negotiation documents to ensure appropriate content.
Collaborates with key stakeholders, i.e. Legal Counsel to modify payer’s standard language, as needed.
Prepares, compiles and consolidates data for reporting to organizational leadership.
Maintain and Model REACH Values (Respect, Excellence, Accountability, Compassion, Honor)
Demonstrates regular, reliable and predictable attendance
Performs other duties as required
Education and Experience Requirements:
Bachelor’s Degree or equivalent experience.
Minimum of three (3) years relevant experience.
Minimum Knowledge, Skills and Abilities Requirements:
Ability to build financial and statistical models, analyze data, and translate analysis into specific, targeted action to drive results.
Proficiency in working with complex and large volumes of data.
Strong problem-solving skills.
Ability to work in a fast paced and changing environment.
Strong organizational and written/oral communication skills.
Ability to work independently and with little supervision.
Excellent ability to manage to deadlines.
License, Registration, or Certification Requirements:
Factors affecting environment conditions may vary depending on the assigned work area and tasks. Potential environmental exposures include, but are not limited to:
Experiencing challenging conditions where a professional attitude will be required
Interacting with a Diverse population
Noise Level – Varies from Quiet to Moderate
Risk of Electrical Shock