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Managed Care Analyst
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Primary Accountability
The Managed Care Analyst is responsible for using health plan data to validate, contrast, and track opportunities for revenue growth and compiling external and internal data reports to ensure compliance and efficiency.
Description of Primary Responsibilities
- Responsible for producing, validating, and interpreting data for health plan membership and capitation reports and developing internal status reports to meet organizational revenue goals.
- Defines data requirements and develops data collection and analysis tools for payer-specific identities.
- Performs data validation to ensure integrity of reporting.
- Identifies, investigates, and reports discrepancies in the data or workflows.
- Maintains a work plan for post-production reports and presentations.
- Produces monthly reports on payer revenue.
- Maintains Compliance Data Base for all Health Plans and special projects.
- Uses collected data to evaluate the profitability of payer relationships for all lines of business:
- Medicare and Medicare Advantage Five Star Performance.
- Medi-Cal Managed Care Health Plan Audit/Compliance and Incentives.
- Commercial Health Plans P4P and HEDIS Performance.
- Health plan contract modeling
- Analyze utilization data such as PCP visits, ER visits, hospital admissions, and bed days and identify opportunities to control utilization.
- Assists data analysis efforts of other FHCN staff and departments as needed.
- Responsible for assessing the effectiveness of internal workflow impact on health plan revenue streams and ensuring current organizational policies follow existing contract terms.
- Other duties as assigned.
Description of Primary Attributes
General Development:
- Possesses basic organizational skills, typically to organize own work.
- Works independently and as part of a team.
- Job responsibilities require individual development of priorities for effective performance of duties, including re-prioritization in response to changes in circumstances.
- Can effectively select from both established alternatives and modify approaches in response to situations encountered.
- Duties require drawing conclusions using inference and logic, which may differ from the conclusions others could draw.
- Consider how work affects other employees outside the department or functional area.
Professional & Technical Knowledge:
- Bachelor’s degree in finance, Math, Business, IS, or a related field.
- Two to three years of relevant experience, including experience with healthcare, preferably in managed care.
- Two-plus years of data analysis or financial modeling.
- Strong analytical and problem-solving skills.
Technical Skills:
- Ability to prepare more complex documents in Microsoft Word, including creating tables, charts, graphs, and other elements.
- Ability to use Advanced Microsoft Excel to analyze data, including formulas, functions, lookup tables, and other standard spreadsheet elements.
- Ability to develop sophisticated presentations in Microsoft PowerPoint, including embedded objects, transitions, and other elements.
Licenses & Certifications: None required.
Communications Skills:
- Job duties require employees to effectively communicate their opinions and extrapolations of information they collect, synthesize/analyze.
- Exercises tact and diplomacy to resolve mild conflicts or disagreements.
- Compiles, analyzes and prepares information in an effective written form, including correspondence, reports, articles, or other documentation.
- Effectively conveys technical information to non-technical audiences.
Physical Demands: Job duties performed under typical office conditions.
Pay Scale:
Min: $69,807.05
Max: $111,691.28
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