Sr. Managed Care Analyst Job in Concord 01742, Massachusetts US
About Emerson Hospital: Emerson Hospital is well-known for its outstanding nursing care and patient-centered facilities including the Birthing Center and special nursery care. A Level II Special Care Nursery enables Emerson Hospital to care for moderately ill newborns. It is the only special care nursery in the area, which provides 24-hour in-house coverage by pediatricians and anesthesiologists.
Emerson's core mission has always been to make high quality health care more accessible to those who live and work in its service area.
While Emerson provides all of the services that most patients will ever need, the hospital's strong relationships with the downtown academic medical centers ensures that our patients have access to world class resources.
At Emerson Hospital, it's beyond compare. You'll find lower patient ratios, ample continuing education opportunities, a collaborative environment with physicians and staff, and state-of-the-art technology.
Job Description
Sr. Managed Care Analyst
SR. MANAGED CARE ANALYST
Job Summary
Reporting to the Senior Vice President and Chief Financial Officer, the Sr. Managed Care Analyst is responsible for working with the Hospital and PHO to ensure that revenue is maximized as a result of contractual relationships with managed care organizations. This person is also responsible for ascertaining whether or not the terms of a contract are operationally feasible, given existing structures and interfaces between the Hospital and PHO. This individual will report to the Chief Financial Officer of Emerson Hospital and work collaboratively with the Executive Director of the PHO.
Job Functions
1. Planning Responsibilities
· Works with appropriate senior organizational management to develop an overall managed care contracting strategy.
· Contributes to the formulation and direction of preliminary strategic contractual analysis, as well as with the evolution of subsequent negotiating tactics.
· Manages process of analysis to assure that conclusions drawn provide desired benefit to the organization.
· Prepares essential information for presentation at PHO Managed Care Contracts Committee meetings, and other related forums, in collaboration with the Executive Director of the PHO and the Chair of the Managed Care Contracts Committee.
2. Policy Responsibilities
· Develops specific criteria designed to manage the organization’s book of managed care contracts.
· Assures that a mechanism is developed that tracks the financial and operational fluidity of contracts on a predetermined, periodic basis.
3. Procedural Responsibilities
· Collaborates with Executive Director of PHO, Chairs of PHO and PHO Contracts Committee and Partners Community Health Care, Inc. (“PCHI”), on an ongoing basis, to assure that risk-based contracts negotiated meet the financial goals of the PHO.
· Negotiates hospital’s managed care agreements, all related sub-contracts, and associated Credentialing processes.
· Reports and updates managed care activity to PHO Managed Care Contracts Committee, on a periodic, and/or as-needed basis.
· Assures accuracy of “Payor Contracts Matrix.”
4. Inside relationships
· Director of Financial Planning/Emerson Hospital: Works in close collaboration with the Director of Financial Planning, Director of Patient Accounts and other finance department staff to maximize third party, commercial contracting efforts.
· Executive Director of the PHO: Collaborates with and supports cohesive leadership initiatives leading toward the attainment of contractual goals of the PHO.
· Emerson Hospital’s Chief Financial Officer: Reports to and consults with CFO to develop targeted managed care negotiating strategies and tactics designed to increase revenue.
· Chair, PHO Contracts Committee: Meets and consults with designated lead physician on an ongoing, predetermined basis (additionally, as needed). Works, collaboratively, to identify relevant key issues, strategize tactical organizational options, and communicate information gathered and developed to the Executive Director of the PHO, and to members of the PHO Managed Care Contracts Committee.
· Chair, PHO: Participates in managed care related strategic planning discussions with Chair, individually and in collaboration with the Executive Director of the PHO, offering ideas and feedback, as appropriate.
· Senior and Middle Hospital Management: Maintains close relationships with all managers supervising primary segments of the Hospital’s business operation. Works collaboratively with members of the management team to identify opportunities to increase revenue and resolve operational issues related to new and/or existing managed care contracts.
· PHO Staff: Works in tandem with PHO Staff to meet the goals and objectives of the PHO managed care contracting effort.
· PHO Physicians: Responds to inquiries related to managed care contracting issues and provides important
feedback to Executive Director of the PHO related to issues/ideas presented by PHO staff physicians.
5. Outside Relationships
· Managed Care Organizations (“MCOs”): Fosters strong, professional and productive relationships with key senior negotiators representing all relevant managed care organizations within our market.
· Management Service Organizations (“MSOs”): Develops relationships with identified decision-makers of various specialty carve-out companies (i.e. Mental Health, Substance Abuse, Home Care, Hospice, Ophthalmology, Laboratory, Radiology, etc.).
· Acton Medical Associates and Concord-Hillside Associates: Identifies key decision-makers representing these two important Hospital referring entities. Fosters the establishment of collaborative relationships designed to maximize revenue flow generated from these physician groups.
6. Other Responsibilities
· Communicates all prospective managed care contracting opportunities to hospital CFO and Executive Director of PHO.
· Works, collaboratively, with PHO physician leadership, PHO physician membership at large, and Hospital senior and middle management to ensure that all managed care contracting opportunities are identified, analyzed relative to their potential value to the organization, and effectively realized, if deemed appropriate.
· Works with appropriate PHO and Hospital staff to implement contracts negotiated.
· Participates as a member of appropriate organizational committees, in an effort to provide creative input, assist with appropriate benchmarking, identify problems, and focus upon reasonable and timely resolution of managed care related issues
· Participates on appropriate MHA and HFMA managed care committees, as the organization’s principal managed care representative.
· Maintains updated contract files containing Hospital and PHO Agreements.
· Reviews TUFTS commercial and Secure Horizons (“SH”) Mental Health/Substance Abuse capitated business activity under DF Agreement at Psychiatry Department’s monthly “TUFTS/SH Contract Meetings.”
· Works in collaboration with the Hospital’s senior management team, Hospital Finance Department personnel, and PHO on various projects related to the analyses of various segments of the organization’s managed care business.
· Maintains and supports patient tights to care, privacy, or respect.
· Other duties as assigned from time to time.
Minimum Qualifications
· Education
o BS Degree or equivalent experience required.
o Evidence of continued coursework in business or healthcare administration required.
o Masters degree preferred.
· Experience
o Substantial background and knowledge of the managed care industry and refined managed care contract negotiation skills.
o Operational experience, within a health care organization required.
· Licensure and/or Certification
o Not Applicable
· Skills
o Ability to think analytically.
o Possesses strong interpersonal/relationship-building skill and attributes.
o Excellent customer service skills.
o Must be able to read, write, and communicate in English.
o Computer skills required.
o Ability to maintain confidential information.
Requirements
Bachelor's Degree
