Managed Care Analyst

Description

Position at GoHealth Urgent Care

Position Description

Reporting to the Chief Strategy Officer, the Managed Care Analyst (Analyst) is responsible for analysis of all current and future payor contract terms, including gathering, storing, and maintaining performance data to support all payor negotiations. The Analyst will use contract terms and performance data to model scenario-based impacts by payor product to help support and inform contracting strategy and negotiations. In addition, the Analyst will act as a liaison with our joint venture partners to request, track and add payor updates to produce rate-trend forecasting/budgeting/reporting models and partner with finance, accounting, central business office and operational teams to distribute and educate on the related data and findings/information.

The Analyst will conduct research on new government healthcare reimbursement and regulations changes (including commercial payor policy changes) and lead communication and coordination with operational teams and the central business office for both required and opportunity implementation. Additional support to prepare and coordinate managed care meetings with payors and health system partners to provide consistent, accurate data and presentations.

Candidate Qualifications

• BS or BA degree in related field.
• Completed coursework in statistics or demonstrated working knowledge of statistical presentation/interpretation of data required
• At least 1 year of work experience in healthcare finance, economics, or managed care.
• Advanced Microsoft Excel and PowerPoint skills required.
• Working knowledge of SQL or other programming language (SAS, R, SPSS, etc.) preferred
• Working knowledge of healthcare industry code systems (ICD, CPT, NDC, etc.) highly preferred
• Ability to work independently.
• Ability to think creatively, highly driven, self-starter.
• Exceptional attention to detail and analysis quality/accuracy
• Excellent analytical skills.
  
  

Candidate Responsibilities

• Lead analysis of all current and future payor contact terms to support new negotiations or renewals, including gathering, storing, and maintaining performance data on denials, patient and payor collections, remittance timing and other key indicators. Use the company market transparency tool to compare rate terms to competitors in the various markets.
• Gather performance data and model scenario-based impact by product to help support and inform commercial payor strategy.
• Request, track and maintain payor contract amendments, renewals, and expansion of service scope to share with internal finance, accounting, and central business office departments.
• Act as a liaison with our joint venture partners to produce rate trend forecasting/budgeting/reporting models and partner with finance, accounting, and operational teams to distribute related data and information.
• Conduct research/monitor new government healthcare reimbursement and regulations changes and lead communication and coordination with operational teams and revenue cycle for proper implementation. Similarly, track and distill changes communicated by commercial insurance payors through bulletin, policy, and other means and both update the internal teams and analyze the financial impacts of such.
• Prepare and coordinate managed care meetings with health system partners to provide consistent, accurate data and presentations.
• Lead managed-care initiatives and support related managed-care data requests from our joint venture partners, inquires from payors and other entities.
• Support new joint venture partner development, including payor information and contract terms to compare and model opportunities.
• Other duties as assigned.