Managed Care Analyst II

ez-cap, excel, contract, contracting, sql, access, crystal, business intelligence, icd-10, cpt
Full Time
Depends on Experience
Work from home not available Travel not required

Job Description

SUMMARY

An integral part of the contracting team, the Managed Care Anaylst II (provider/vendor maintenance) will maintain responsibility for the analysis, modeling, interpretation and loading of healthcare/managed care contractual agreements for Provider, Ancillary, or Specialist in the EZ-Cap software solution.

SUPERVISORY RESPONSIBILITIES

This position has no supervisor responsibilities.

POSITION INTERACTS WITH

Administration Department

UM/QM Department

Claims Department

Finance Department

Human Resource Department

Physicians

Health Plans

Vendors

ESSENTIAL DUTIES & RESPONSIBILITIES

While upholding and supporting the philosophy, objective and policies of Desert Physicians Management, LLC and Choice Medical Group the essential duties and responsibilities include the following, other duties may be assigned:

  • Load the credentialed providers as participating or non-participating into Ezcap database
  • Analyze, interpret and loads contractual agreements data into the Ezcap database
  • Codes Contracts for loading
  • Create an exception fee set when needed
  • Tests the database for claims accuracy and ensures automation for adjudication
  • Audits the database and sweeps for discrepancies in Ezcap database
  • Provides quantitative analysis in validating payer contract reimbursements against Ezcap calculations using patient accounting data
  • Researches new calculation methodologies, contract reimbursement terms, and payment formula
  • Configures the Contracting database and creates Excel spreadsheets to house all rates in one universe updated monthly for Administration review
  • Updates provider data accordingly as well as Pay to: information
  • Responsible for preparing live testing for Annual Contracting/Claims audits
  • Attaches contract to provider profile for Claims/Contracting audits
  • Ensures Federal W9 s are attached to profiles
  • Troubleshoots errors when claims sends over specific errors in the Ez-cap Database

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions

Knowledge of :

  • ICD-10, HCPCS, and CPT coding *is a must for contract interpretation and loading*
  • Health plan/vendor contracting
  • Company policies and procedures
  • Microsoft office applications and Excel spreadsheets
  • MS Word
  • EZ-CAP managed care solution system
  • Intermediate to advanced experience with Microsoft Excel, including pivot tables, formula calculations, and V-look ups
  • Familiar with Ez-cap database
  • Familiar with Access
  • Experience understanding / writing algorithmic type logic

Ability to:

  • Problem-solve, negotiate and demonstrate independent decision-making
  • Prioritize with excellent organizational skills, responding to multiple demands and timeliness
  • Demonstrate professional written and verbal communication skills and presentation skills using the English language
  • Demonstrate project management skills, including the ability to plan a project and stay within plan and budget
  • Demonstrate ability to respond to common inquiries from patients, customers, vendors, regulatory agencies, health plans or member of the business community and possess excellent customer service skills
  • Twist, turn and utilize reaching motion, ability to sit and/or stand for extended periods of time

SKILLS

Has knowledge of industry standards and expectations. Has knowledge of commonly used concepts, practices and procedures within this field. Excellent verbal and written skills. Computer literate with knowledge of EZ-Cap and Microsoft Applications. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. Works independently under the direction of the Information Technology Director. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

EDUCATION and/or EXPERIENCE

High school diploma and a minimum of 3- years related experience and/or training.

LANGUAGE SKILLS

Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or government regulations. Ability to write reports and/or business correspondence. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

REASONING ABILITY

Ability to solve practical problems and deal with a variety of concrete variable in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

CERTIFCATES, LICENSES, REGISTRATIONS

None.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to stand, walk, sit and use the computer and telephone. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 15 pounds.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those and employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Dice Id : 91109544
Position Id : 6287761
Originally Posted : 2 weeks ago
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