Job Summary The Managed Care Contract Analyst I assists in managing the ongoing review of actual payor payments versus expected payments through the process of routine retrospective auditing of payments. Assists with data mining and performing managed care contract analyses for various clients on a regular basis, including summarizing financial trends and impacts for Hospital, Physicians' Organization, and Pediatric Physicians' Organization at Children's Hospital (PPOC). Aides in the development of auditing schedules, tracking mechanisms and coordinating the pursuit of the recovery of net revenue, rebilling of claims and/or settlement opportunities. Helps identify over and underpayments based on contract intent. Extensive knowledge of payor contracts and relevant documents to payor reimbursement, coverage and authorization policies.
The Managed Care Contract Analyst I shall be responsible for:
Designing and building simple financial models to support various reporting and contracting needs. Working with other departments within the organization and leveraging internal reporting systems to gather and compile the required data.
Employing basic understanding of Hospital/physician contractual reimbursement methodologies. Preparing appropriate analyses for review by various committees and senior leadership.
Preparing monthly, quarterly and yearly payer contract performance reports and presents performance trends at the department all staff meeting. Preparing and distributing monthly reports for financial close process, consistently following established procedures for formatting and accuracy.
Maintaining and updating the Managed Contract System based on commercial and governmental contracts. Performing system set up and testing as necessary to ensure contracts are accurately configured and modeled.
Compiling quarterly and annual Hospital/physician fee schedules as required by payer contracts. Distributing fee schedules to internal and external clients as needed. Maintaining organized and well‑documented project files.
Researching and analyzing financial data for internal and external clients. Creating, organizing, and maintaining files using database and spreadsheet programs; retrieving and organizing data into required reporting formats.
Developing, preparing, and presenting a variety of ad-hoc reporting, financial models and analyses as requested.
Providing functional support to Analyst II and Senior Analyst for various projects as needed. Leveraging Analyst II and Senior Analyst for shared knowledge and expertise. Providing constructive feedback to colleagues in a timely manner to improve output.
Performing other tasks as assigned.
Staffing finance-related Committees, as required.
In order to qualify you must have:
A Bachelor's Degree in a Business/Finance or a closely related field
Analytical and problem-solving skills: collect information from multiple sources, check information for reasonability, and identify conflicting information.
A willingness and ability to learn about healthcare data sets and data systems, financial reporting processes, and external market dynamics.
Organization and documentation of variables, assumptions, and data sources.
Ability to follow standardized processes accurately and consistently.
Familiarity with MS Office applications, in particular Excel. Technical skills to execute common Excel formulas (sum, if, Vlookup, pivot tables).
Ability to communicate effectively both orally and in writing, and provide empathy in difficult interpersonal situations.
Boston Children's Hospital offers competitive compensation and unmatched benefits, including a rotating days/evenings and week-end schedule, affordable health, vision and dental insurance, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition Reimbursement, cell phone plan discounts and discounted rates on T-passes (50% off). Discover your best.
Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care. As one of the largest pediatric medical centers in the United States, Children's offers a complete range of health care services for children from birth through 21 years of age.