Managed Care Analyst/Administration - Full Time

JOB TITLE:        MANAGED CARE ANALYST 

DEPARTMENT:        ADMINISTRATION

GENERAL SUMMARY

The Managed Care Analyst is responsible for performing analysis of claims through the Contract Management System.  

GIBSON AREA HOSPITAL & HEALTH SERVICES MISSION STATEMENT

To provide personalized, professional healthcare services to the residents of the Communities we serve.

PRINCIPLE DUTIES AND RESPONSIBILITIES

1.    Analyze claims that create variances in the Contract Management System.  

2.    Identifies those claims that are true variances and directs them to the appropriate place based on discovery.  Claims may be directed to:    

a.    Insurance Companies
b.    Billing Department
c.    Coders
d.    Denials Department

3.    Develops and maintains appropriate communication with insurance payers, outside agencies and internal departments of Gibson Area Hospital & Health Services (GAHHS). 

4.    Create task logs and follow-up to keep track of claims that are questioned. 

5.    Appropriately refers all non-routine issues to management for clarification.

6.    Accountable for updating and preparing correspondence to insurance payers as necessary.

7.    Ability to work with fellow staff in a friendly, courteous and professional manner.

8.    Stays abreast on health plans, HFS, and Medicare changes.

9.    Maintains confidentiality in all aspects of the position.

10.    All other duties assigned by Director of Managed Care Contracting.

PHYSICAL REQUIREMENTS

1.    Work requires knowledge of computer systems and other office equipment.  

2.    Light level of physical effort required for a variety of physical activities to include lifting (up to 20 lbs.), standing and sitting at a workstation for up to four hours at a time. 

3.    Work requires visual acuity necessary to observe and obtain information and use documentation.

4.    Auditory acuity to hear others for purposed of fluent communication.

REPORTING RELATIONSHIP

Reports to the Director of Managed Care Contracting.  
 

EDUCATION, KNOWLEDGE AND ABILITIES REQUIRED:

1.    High School Diploma, GED, or Equivalent.

2.    Prior experience in billing practices and claims analysis.

3.    General knowledge of mathematics and accounting principles.

4.    Knowledge of billing forms required for different insurance plans.

5.    Knowledge of Medical Terminology.

6.    Familiar with the Legal and Ethical Compliance in charging and billing.     

7.    Requires analytical skills to perform financial analysis on discrepancies between payer payment and contract reimbursement.  

8.    Knowledge of patient’s rights.

9.    Good communication skills, organizational skills, and time management.

10.    General knowledge of contracting principles as well as reimbursement methodologies.  

11.    Educational conferences as requested.  

INFECTION EXPOSURE RISK LEVEL
Category 3 - No Risk - Your job does not involve exposure to blood, body fluids or tissue.  You do not perform or help in emergency medical care or first aid as part of your job. 
WORKING CONDITIONS

1.    Works in an office where there are relatively few discomforts due to dust or dirt.  

2.    Works in an office where there is exposure to noise that can lead to distraction.  Must be able to maintain focus and ability to stay on task.