Managed Care Senior Analyst - Professional Billing (Remote)

Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values. Keep the Service Excellence statement as first item.

Maintains the managed care contract database by accurately loading contract rate schedules in Epic.

Performs audits on managed care contract database to ensure that accounts are calculating correctly.

Analyzes managed care data leading to the development of contract strategy.

Develops contract models to evaluate current contract performance yields.

Constructs new contract models during the evaluation of contract proposals.

Generates productivity, KPI, recovery, and audit reports.

Works with AVP, Revenue Optimization and SBO to develop strategy, evaluate contract language, and implement all third-party managed care contracts for McLeod Health.

Works with Information System to ensure data validation of the daily imports.

Completes facility credentialing required by contracted payers.

Performs other duties as assigned by Leadership.

Work Schedule: 80 hours bi-weekly

Preferred Qualifications /Training:

Experience with data manipulation, word processing, spreadsheets, and data analysis to report trends/patterns/statuses. Must be proficient with MS Excel.

Working knowledge of managed care terminology, managed care reimbursement methodologies, and billing/coding terminology (i.e ICD-10, CPT, Revenue Codes) preferred.

Working knowledge of Patient Financial Services

Excellent interpersonal, written and organizational skills required.

Experience in a progressive healthcare environment with responsibilities for data analysis preferred. Attention to detail and accuracy skills required.

1 Year of EPIC Contract Management build experience (Preferred)

Must be flexible, able to work independently and able to achieve deadlines and deliverables with minimal supervision.

Experience with problem solving techniques

Licenses/Certifications/Registrations/Education:

Associates Degree in Business/Healthcare/Computer Science plus 3 years of experience in healthcare finance preferred. High School Diploma plus 8 years of experience in healthcare finance required. Certified in Resolute Hospital Billing Expected Reimbursement Contracts Administration and Resolute Professional Billing Reimbursement Contracts preferred.

Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area.

With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon and McLeod Behavioral Health.

If you would enjoy working in a dynamic environment and are looking for an opportunity to become part of a stellar team of professionals, we invite you to apply online today. We are an equal opportunity employer.