Mercy Health Managed Care Analyst in Cincinnati, Ohio

Managed Care Analyst

Job ID: 4650178

Updated: June 19, 2017

Geographic Location: HomeOffice

Location: Cincinnati, OH, United States

Department: Payor Contracting

Full/Part Time: Full-Time

Shift: Days

Standard Hours: 40

Job Summary

General Purpose:

The Managed Care Analyst reports to the Director of Health Economics, Contract Modeling & Optimization and is directly responsible for managed care financial analysis, reimbursement modeling, and the monitoring and management of financial data related to managed care contracts for the Mercy Health system. The position collaborates with Payer Contracting, Decision Support, Revenue Cycle, Patient Financial Services, Accounting, Finance and regional staff, as necessary, in performing the analysis/modeling/monitoring activities.

Essential Functions & Responsibilities:

It is expected that all of the Principal Duties and Responsibilities identified below will be performed in a manner that reflects the values of Mercy Health, which are: Compassion, Excellence, Human Dignity, Justice, Mercy, Sacredness of Life, and Service.

  • Performs financial analyses on contract activity for hospitals and physicians, including volume of services, volume and profitability trends, cost and charge structures, volume and profitability by service and by contract, payer migration studies, and other analyses necessary to support the accuracy and profitability of managed care contracting initiatives.
  • Tracks ongoing financial performance, service volume and key utilization data of individual managed care contracts and develops and provides regular reports to management both at the region and system level.
  • Obtain data and model managed care contract reimbursement terms using the Contract Management/Decision Support systems and Excel.
  • Work with other Health Economics staff on the standardization of processes, reporting and approaches to managed care analytics.
  • Participates in short and long term projects, as needed.
  • Maintains knowledge and understanding of the current trends and developments in the healthcare industry to include: service delivery, reimbursements, compliance/regulations, policies & procedures of Governmental and Commercial payers.
  • Adheres to the standards and policies of the Corporate Responsibility Program, including the duty to comply with applicable laws and regulations, and reporting to designated leader (or employer hotline) any suspected unethical, fraudulent, or unlawful acts or practices.
  • Participates in and encourages associates to participate in activities that benefit the community.

Knowledge, Skills & Experience:

  • Strong analytical, critical thinking, verbal and presentation skills. Ability to establish effective working relationships with internal customers and external business partners. The best candidates will display innate curiosity and a passion for solving problems with a positive, willing attitude.

  • Two or more years of relevant experience is preferred.

  • Proficient in use of database programs and Excel.
  • Bachelor’s degree required. Prefer degree in Business Administration, Healthcare Administration or closely related field.

Shift and Job Schedule

40 hours/week

1st shift - 8AM until 5PM

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Equal Employment Opportunity

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.