Managed Care Analyst

Nemours is seeking a Managed Care Analyst (remote) to join our Nemours Children's Health team in Florida or Delaware.

This position provides analytical support to Nemours departments in such areas as Nemours Business Operations, Administration, Strategic Planning, Finance, both Practice and Facility, and other areas across the enterprise.

This position will construct and manipulate large databases to produce reports necessary for contract negotiations (including but not limited to: fee-for-service, value-based reimbursement, per diem, DRG, and % of Charge agreements), acquisitions, annual budgeting, price transparency, payor audits, and payor performance.

Essential Functions

1.

Performs audits of existing contracts to ensure our internal processes and systems, as well as the contracted organization are all in compliance with executed contracts; provides detailed analysis of all results including full impact on finances and internal processes, of non-compliance and developments that potentially impact contract compliance.

2.

Prepares contract financial analysis for acquirement, negotiation and/or termination of contracts.

3.

Provide reports that summarize findings and provides recommendations to Management of all analyses performed, routine or otherwise.

4.

Reviews the different types of fees and its application to different location and insurance classifications; comparison between commercial and government payer, utilization of different codes and updates on national fee schedules.

5.

Performs routine, and ad-hoc financial reporting for other groups within Managed Care and outside departments.

Providing analysis, findings and/or recommendations as requested.

6.

Develops and maintains reporting tools related to reports and databases used within the Managed Care Department.

Performance Skills

1.

Standard level of comprehension of the EPIC system; with a specific emphasis on information related to patient billing and collections; managed care fee schedules; and payer information.

2.

Standard level of proficiency in Microsoft Office (i.e., Excel and Access)

3.

Knowledge and understanding of Managed Care contracts and contract negotiations.

4.

Ability to work independently

5.

Demonstrates continuous improvement and taking initiative

Requirements

Bachelor's degree required

Three to five years of experience required