133 Molina Healthcare jobs in Long Beach
Managed Care Coordinator
Posted 7 days ago
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Job Description
Job DescriptionBring your whole self to exceptional care. Cedars-Sinai was tied for #1 in California in U.S. News & World Report's "Best Hospitals " rankings, and it's all thanks to our team of 14,000+ remarkable employees!What will I be doing in this role?In collaboration with the department Senior Vice President and department directors, the Managed Care Coordinator supports the strategic, operational, and administrative functions of the Managed Care and Payer Relations department. Supports critical initiatives, contract implementation, credentialing, payer relations, and departmental compliance. Works closely with leadership to ensure department goals align with broader Health System objectives.The Managed Care Coordinator collaborates with leadership, clinical departments, and external partners to ensure accurate documentation, timely communication, and effective execution of managed care functions. In this multifaceted role, the Managed Care Coordinator assists with payer Requests for Information (RFIs), contract documentation, and Letters of Agreement (LOAs), while also managing credentialing tasks, onboarding, and regulatory reporting. The position also supports departmental budgeting processes, provides operational support, and contributes to special projects related to payer strategy, compliance, and service delivery across the health system. Duties include: Coordinates and supports managed care operations and departmental services, including drafting and tracking patient-specific Letters of Agreement (LOAs) and providing backup for health plan inquiries. Facilitate drafting and production of payer contract amendments and other related documents as part of onboarding process of new affiliated physicians and physician groups. Develops, implements and manages departmental policies and procedures related to payer and specialty contract and compliance monitoring to ensure alignment with internal and external reporting requirements. Completes credentialing and recredentialing applications for health plans covering faculty practice and affiliated entities (e.g., CSMC, MDRH). Collaborates with leadership to drive cross-functional process improvements, enhance communication, and promote collaborative problem-solving. Leads or assists in coordinating the annual AHA hospital services survey responses for areas related to managed care. Manages Requests for Information (RFIs) from health plans and payers for specialty services, reviewing submissions for appropriateness and advancing concerns (e.g., financial or contract-related data) to leadership. Coordinates and communicates RFI deadlines and follow-ups with internal departments and payers to ensure timely responses. Collaborates with transplant program leaders to compile clinical and administrative data for solid organ and bone marrow transplant RFIs and Center of Excellence proposals. Maintain current and accurate compliance documentation (e.g., licensure, insurance, JCAHO) on shared drives to support audits and regulatory readiness. Works with department leadership to develop and manage the annual budget, including data entry into Axiom and liaising with Finance for revisions and analysis. Monitors expenditures and controlling departmental budget, performs account analysis and preparation of monthly variance reports for leadership review. Oversees administrative HR functions including timecard approvals, time-off tracking, new hire orientation, and mandatory training (e.g., C-S Fire and Disaster Plans). Coordinates technical and operational supports needs (e.g., EIS support tickets and requests for tools like DocuSign) to maintain workflow continuity. Leads the creation, development, and ongoing maintenance of a comprehensive payer database to support effective communication and ensure contract compliance. Distributes contract amendments, payer notifications, and provider manual updates to relevant internal collaborators. Develops and maintains databases and tracking tools to monitor RFI status and prepare and submit monthly outcome reports.QualificationsRequirements:Bachelor's degree in business administration, finance or another relevant major required.A minimum of 5 years' experience in managed care, healthcare administration, credentialing, or payer relations, preferably in an academic medical center or integrated health system required.In this role you will demonstrate initiative, resourcefulness and problem- solving skills in organizing and prioritizing work and establishing systems and procedures. The position requires strong customer service and interpersonal skills to effectively work with payers, administration, attorneys and co-workers.Why work here?Beyond outstanding employee benefits including health and dental insurance, paid vacation, and a 403(b) we take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation.
Managed Care Coordinator
Posted 7 days ago
Job Viewed
Job Description
Bring your whole self to exceptional care. Cedars-Sinai was tied for #1 in California in U.S. News & World Report's "Best Hospitals " rankings, and it's all thanks to our team of 14,000 remarkable employees! What will I be doing in this role? Care Coordinator, Coordinator, Department Leader, Leadership, Support, Health, Healthcare
Managed Care Coordinator
Posted 5 days ago
Job Viewed
Job Description
Bring your whole self to exceptional care. Cedars-Sinai was tied for #1 in California in U.S. News & World Report's "Best Hospitals " rankings, and it's all thanks to our team of 14,000+ remarkable employees!
**What will I be doing in this role?**
In collaboration with the department Senior Vice President and department directors, the Managed Care Coordinator supports the strategic, operational, and administrative functions of the Managed Care and Payer Relations department. Supports critical initiatives, contract implementation, credentialing, payer relations, and departmental compliance. Works closely with leadership to ensure department goals align with broader Health System objectives.
The Managed Care Coordinator collaborates with leadership, clinical departments, and external partners to ensure accurate documentation, timely communication, and effective execution of managed care functions. In this multifaceted role, the Managed Care Coordinator assists with payer Requests for Information (RFIs), contract documentation, and Letters of Agreement (LOAs), while also managing credentialing tasks, onboarding, and regulatory reporting. The position also supports departmental budgeting processes, provides operational support, and contributes to special projects related to payer strategy, compliance, and service delivery across the health system. Duties include:
+ Coordinates and supports managed care operations and departmental services, including drafting and tracking patient-specific Letters of Agreement (LOAs) and providing backup for health plan inquiries.
+ Facilitate drafting and production of payer contract amendments and other related documents as part of onboarding process of new affiliated physicians and physician groups.
+ Develops, implements and manages departmental policies and procedures related to payer and specialty contract and compliance monitoring to ensure alignment with internal and external reporting requirements.
+ Completes credentialing and recredentialing applications for health plans covering faculty practice and affiliated entities (e.g., CSMC, MDRH).
+ Collaborates with leadership to drive cross-functional process improvements, enhance communication, and promote collaborative problem-solving. Leads or assists in coordinating the annual AHA hospital services survey responses for areas related to managed care.
+ Manages Requests for Information (RFIs) from health plans and payers for specialty services, reviewing submissions for appropriateness and advancing concerns (e.g., financial or contract-related data) to leadership. Coordinates and communicates RFI deadlines and follow-ups with internal departments and payers to ensure timely responses.
+ Collaborates with transplant program leaders to compile clinical and administrative data for solid organ and bone marrow transplant RFIs and Center of Excellence proposals.
+ Maintain current and accurate compliance documentation (e.g., licensure, insurance, JCAHO) on shared drives to support audits and regulatory readiness.
+ Works with department leadership to develop and manage the annual budget, including data entry into Axiom and liaising with Finance for revisions and analysis. Monitors expenditures and controlling departmental budget, performs account analysis and preparation of monthly variance reports for leadership review.
+ Oversees administrative HR functions including timecard approvals, time-off tracking, new hire orientation, and mandatory training (e.g., C-S Fire and Disaster Plans). Coordinates technical and operational supports needs (e.g., EIS support tickets and requests for tools like DocuSign) to maintain workflow continuity.
+ Leads the creation, development, and ongoing maintenance of a comprehensive payer database to support effective communication and ensure contract compliance. Distributes contract amendments, payer notifications, and provider manual updates to relevant internal collaborators. Develops and maintains databases and tracking tools to monitor RFI status and prepare and submit monthly outcome reports.
**Qualifications**
**Requirements:**
+ Bachelor's degree in business administration, finance or another relevant major required.
+ A minimum of 5 years' experience in managed care, healthcare administration, credentialing, or payer relations, preferably in an academic medical center or integrated health system required.
+ In this role you will demonstrate initiative, resourcefulness and problem- solving skills in organizing and prioritizing work and establishing systems and procedures. The position requires strong customer service and interpersonal skills to effectively work with payers, administration, attorneys and co-workers.
**Why work here?**
Beyond outstanding employee benefits including health and dental insurance, paid vacation, and a 403(b) we take pride in hiring the best, most passionate employees. Our accomplished staff reflects the culturally and ethnically diverse community we serve. They are proof of our commitment to creating a dynamic, inclusive environment that fuels innovation.
**Req ID** : 11551
**Working Title** : Managed Care Coordinator
**Department** : Managed Care and Payor Relations
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Strategic Plan / Business Dev
**Job Specialty** : Managed Care
**Overtime Status** : EXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $38.88 - $60.26
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.
Revenue & Managed Care Analyst
Posted 1 day ago
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Job Description
POSITION SUMMARY
The Revenue and Managed Care Analyst plays a key role in supporting the financial performance of the hospital by analyzing managed care contracts, payer reimbursement trends, and revenue cycle performance metrics. The Analyst supports the mission of the community safety net hospital by ensuring accurate reimbursement from managed care payers, particularly Medicaid and other government programs. This role is critical in analyzing payer performance, optimizing managed care contracts, and improving revenue cycle operations to sustain care for underserved and vulnerable populations.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Analyze managed care contracts to assess payment methodologies, reimbursement structures, and contract compliance.
- Assist in financial impact analysis to support payer negotiations and renewals.
- Review proposed contract terms for financial feasibility and alignment with hospital revenue goals.
- Investigate and resolve payer-related issues that impact accounts receivable, including payment variances and delays.
- Monitor and identify trends in payer behavior that may affect the hospital's financial sustainability, especially with Medicaid and local health plans.
- Collaborate with billing, coding, and denial management teams to research root causes and recommend solutions.
- Act as a liaison between revenue cycle operations, managed care contracting, finance, and patient financial services and collaborate to resolve complex payer issues.
- Participate in cross-functional meetings to improve payer relationships and revenue performance (Joint Operations Comittiee- JOC)
- Partner with finance and billing vendors to ensure contract terms are accurately reflected in vendor's billing systems.
- Communicate findings, insights, and recommendations clearly to both technical and non-technical stakeholders.
- Other duties as assigned
POSITION REQUIREMENTS
A. Education
- Bachelor's degree in Healthcare Administration, Finance, Business, or related field required; Master's degree preferred.
- Minimum 3-5 years of experience in healthcare revenue cycle, payer analysis, or managed care analytics in a hospital setting.
- Experience with claims analysis, and payer reimbursement methodologies.
- Proficient in hospital billing systems (e.g., Cerner) and data tools (Excel, Word, etc)
- Knowledge and understanding of DRG, APC, CPT, ICD-10, and revenue codes.
- Knowledge of Medicare/Medicaid and commercial payer billing regulations.
- Analytical mindset with attention to detail and problem-solving ability.
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Managed Care Organization EDI Developer - Managed Care Operations - FT Days
Posted 7 days ago
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Job Description
UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America's Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County's only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.
To learn more about UCI Health, visit
Your Role on the Team
Position Summary:
Position supports the Managed Care operations of UCI Health with respect to development, implementation and ongoing maintenance of all inbound and outbound Electronic Data Interchange (EDI) transactions for a managed care group. Incumbent will work with claims and payment teams on the HIPAA 837 -Health Care Claim and 835-Health Care Claim Payment/Advice, including working with Cirius and Office Ally. Additionally, position oversees ingestion of membership and eligibility files, lab and pharmacy data rexchanges and care-gaps files from health plans. Incumbent is responsible for all health plan reporting requirements required by health plan contracts. The incumbent will work collaboratively with information systems staff, government and third-party payers, clearinghouses, and Epic technical support personnel to implement these transactions in an integrated, efficient, and cost-effective manner. This position will have responsibility for planning, implementing and managing HIPAA EDI projects relating to these transactions, including end-user contact, analysis, design, mapping, programming, training and documentation.
What It Takes to be Successful
Total Compensation
We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.
Required Qualifications:
- Strong project management skills including the ability to effectively manage multiple projects and tasks simultaneously
- Strong critical thinking and problem-solving skills to manage complex information, assess problems, and develop effective solutions
- Self-motivated and works independently on projects, from conception to completion and able to meet deadlines
- Must possess the skill, knowledge and ability essential to the successful performance of assigned duties
- Experience with file formats and reporting including but not limited to HCFA EDI or HL7, FHIR formats, CALLINK, RxHub
- Excellent organization and project management skills
- Demonstrated excellent organizational skills and possess the ability to design, set up and manage internal processes and protocols
- Demonstrated excellent interpersonal skills
- Demonstrated ability to communicate technical information to technical and non-technical personnel at various levels in the organization
- Associate's Degree in Business, Finance, Health Information Technology, or another related field
- Advanced written and verbal communication skills with the ability to convey complex information in a clear, concise manner.
- Advanced knowledge of business and data process analysis functions
- Ability to maintain a work pace appropriate to the workload
- Ability to be forward thinking and anticipate problems and solutions
- 5 years of experience Electronic Data Interchange (EDI) experience
- Revenue Cycle (healthcare business, financial or insurance) experience
- Prior experience with HealthPlan and EDI providers
- Prior EPIC experience
- Office Ally experience
- Knowledge of medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, 1500)
- Knowledge of University and Medical Center organizations, policies, procedures and forms
The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:
- Background Check and Live Scan
- Employment Misconduct*
- Legal Right to Work in the United States
- Vaccination Policies
- Smoking and Tobacco Policy
- Drug Free Environment
The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.
- California Child Abuse and Neglect Reporting Act
- E-Verify
- Pre-Placement Health Evaluation
Details of each policy may be reviewed by visiting the following page:
Closing Statement:
The University of California, Irvine is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC nondiscrimination policy.
We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.
UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at or at , Monday - Friday from 8:30 a.m. - 5:00 p.m.
Consideration for Work Authorization Sponsorship
Must be able to provide proof of work authorization
Sr. Managed Care Biller Collector
Posted today
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Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one Biller, Collector, Healthcare, Billing, Technology, Hospital
Regional Director - Managed Care Compliance
Posted 6 days ago
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Job Description
Join to apply for the Regional Director - Managed Care Compliance role at Torrance Memorial
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Join to apply for the Regional Director - Managed Care Compliance role at Torrance Memorial
- Establishes and coordinates an effective, comprehensive Managed Care Compliance Program in accordance with federal, state and health plan requirements for all enterprise managed care operations. Oversees all aspects of the Managed Care Compliance Program, and works to enhance existing compliance programming, developing new policies and procedures and monitoring existing policies and procedures as appropriate to ensure full compliance with applicable laws, regulations, accrediting organizations and contractual obligations.
- Oversees Policy and Procedure Management which includes ensuring that compliance policies and procedures within managed care operations are up to date. Ensures providers receive and understand these policies and provide evidence to health plan that the policies were distributed and received by providers.
- Provides leadership, training and support to all direct reports, and provides daily supervision of Compliance Department staff.
- Working in collaboration with business unit owners, ensures policies and procedures related to delegated operations are compliant with regulatory, accrediting body and contractual requirements.
- Establishes/implements monitoring programs to ensure compliance and keeps records of all compliance activities in accordance with retention of records policies.
- Serves as the primary compliance contact for external stakeholders, including the health plans, accreditation bodies and regulators.
- Manage Compliance Departments administrative duties, including but not limited to organizing and maintaining complete department files, records, documentation, project plans and calendars.
- Prepares comprehensive, timely executive-level reports with regular cadence to keep leadership aware of audit status, compliance risks, etc.
- Fully and timely report to all appropriate leaders and staff of upcoming audits audit results, corrective actions so thet the enterprise is fully prepared for optimal audit performance.
- Identifies potential areas of compliance vulnerability and risk and prepares annual Compliance Risk Assessment that identifies these risks. Works with operational leaders and SMEs to developmitigation plans to address as appropriate.
PRIMARY DUTIES AND RESPONSIBILITIES:
- Establishes and coordinates an effective, comprehensive Managed Care Compliance Program in accordance with federal, state and health plan requirements for all enterprise managed care operations. Oversees all aspects of the Managed Care Compliance Program, and works to enhance existing compliance programming, developing new policies and procedures and monitoring existing policies and procedures as appropriate to ensure full compliance with applicable laws, regulations, accrediting organizations and contractual obligations.
- Oversees Policy and Procedure Management which includes ensuring that compliance policies and procedures within managed care operations are up to date. Ensures providers receive and understand these policies and provide evidence to health plan that the policies were distributed and received by providers.
- Provides leadership, training and support to all direct reports, and provides daily supervision of Compliance Department staff.
- Working in collaboration with business unit owners, ensures policies and procedures related to delegated operations are compliant with regulatory, accrediting body and contractual requirements.
- Establishes/implements monitoring programs to ensure compliance and keeps records of all compliance activities in accordance with retention of records policies.
- Serves as the primary compliance contact for external stakeholders, including the health plans, accreditation bodies and regulators.
- Manage Compliance Departments administrative duties, including but not limited to organizing and maintaining complete department files, records, documentation, project plans and calendars.
- Prepares comprehensive, timely executive-level reports with regular cadence to keep leadership aware of audit status, compliance risks, etc.
- Fully and timely report to all appropriate leaders and staff of upcoming audits audit results, corrective actions so thet the enterprise is fully prepared for optimal audit performance.
- Identifies potential areas of compliance vulnerability and risk and prepares annual Compliance Risk Assessment that identifies these risks. Works with operational leaders and SMEs to developmitigation plans to address as appropriate.
COMPLIANCE: Serves as Chair of the Managed Care Compliance Committee. Prepares agenda and arranges for the regular and ad hoc meetings of the Managed Care Compliance Committee
Supervisory/Management Responsibilities
Manages Compliance Department staff to include overseeing the work of others, assigning or allocating work to team, and ensuring work is completed according to deadlines and quality standards.
Teamwork/Customer Relations Responsibilities
Collaborates to make decisions to achieve desired outcomes
Establishes effective working relationships with cross-functional teams, external stakeholders.
JOB QUALIFICATIONS:
Education:
Bachelors degree from an accredited four-year institution required
Masters degree in healthcare administration, Law, Public Administration, or Business Administration strongly preferred.
Work Experience:
Minimum 7 years work experience in regulatory affairs and/or compliance
Minimum 5 years work experience in California managed care regulatory affairs and/or compliance
Minimum 5 years work experience in providing guidance to senior level leaders
Licenses and Certifications
Certification In Healthcare Compliance - Preferred
Salary Range: $125,000 - $85,000,000/yr
Seniority level
- Seniority level Director
- Employment type Full-time
- Job function Health Care Provider
- Industries Hospitals and Health Care
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Managed Care and Payor Relations Director, Managed Care - #1 Hospital in CA
Posted 5 days ago
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Job Summary
The Director of Managed Care develops and implements managed care and payer relations strategies including contract negotiation and management of payer relationships for all Cedars-Sinai-owned and affiliated entities including hospitals, physician groups, individual practice association (IPAs), accountable care organizations, and procedural/surgery centers. Responsible for negotiating insurance contracts and payer agreements that enable Cedars-Sinai to meet its financial objectives and mission through continuous and thorough analysis in evaluating existing structures and rates. Provides leadership to maintain effective payer partnerships through establishing, maintaining and growing relationships with internal and external stakeholders involved in the contracting process, developing contract language and negotiation strategy, and in-depth financial analyses of contract performance. Oversees assigned Health Plans in scope and serves as key business contact between Cedars-Sinai entities and payers to resolve issues as they arise including operational, financial, payment, clinical, policy interpretations and others. Provides leadership, guidance and supervision to staff towards the accomplishment of organizational goals.
Primary Duties & Responsibilities
+ Leads the negotiation, development, and monitoring of contracts across all Cedars-Sinai entities, serving as the primary contact for major payers (e.g., Anthem, United, Aetna).
+ Develops negotiation strategies and contract structures including fee-for-service, capitation, bundled payments, value-based care, and pay-for-performance models.
+ Performs in-depth financial analyses to assess contract performance and guides decisions on renewal, cancellation, or renegotiation.
+ Oversees the Letter of Agreement (LOA) process for non-contracted and out-of-network payers in coordination with Registration, Admissions, Payer Revenue Management, and Service Lines.
+ Supports recovery of unpaid/underpaid receivables and serves as liaison between internal departments and health plans.
+ Supervises contracting efforts that support patient referrals and participation in specialty networks (e.g., transplant services).
+ Manages analytics and actuarial support for both facility and physician contracts, including at-risk arrangements.
+ Provides market insights on payer trends, coding protocols, regulatory changes, and emerging technologies to guide strategy and protect revenue.
+ Collaborates with internal stakeholders and industry groups (e.g., CHA, HASC, APG) to shape and align Cedars-Sinai's managed care strategy.
**Qualifications**
Education:
+ **Bachelor's Degree Required** - Business, Finance, health care or a related field
+ Master's Degree Preferred- Master of Business Administration (MBA), Master of Healthcare Administration (MHA), Master of Public Health (MPH), or a related field
Work Experience:
+ **Minimum of 10 years of progressive experience** in managed care contracting at the management or supervisory level, within a health plan or provider setting. At least **3 of those years** should be within a large, diverse health system, with specific experience in **hospital and physician contracting** . Must have a strong understanding of **risk-based arrangements and capitation management** .
**About Us**
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.
**Req ID** : 10874
**Working Title** : Managed Care and Payor Relations Director, Managed Care - #1 Hospital in CA
**Department** : Managed Care and Payor Relations
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Strategic Plan / Business Dev
**Job Specialty** : Managed Care
**Overtime Status** : EXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $87.49 - $157.48
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.
Business Analyst - Health Plan / Managed Care
Posted today
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We need a Business Analyst with Health Plan / Managed Care experience for a 6+ month contract role for a Healthcare client in Los Angeles, CA.
This role will be Remote full time for the first several months, but will convert to being a HYBRID remote/onsite role in the future. This means we strongly prefer someone who lives in CA . The role may also convert to Full Time Equivalent (FTE) status after 6 months, so we strongly prefer candidates who have a Green Card or are a US Citizen .
Job Summary
The Enterprise Portfolio Management Office Solutions Analyst is accountable for intake, execution, and managing the oversight of strategic programs and projects approved and budgeted by Leadership. These programs and projects span multiple functions and departments, and are enterprise investments in infrastructure and process excellence. The portfolio, program, and project management resources within the ePMO are uniquely positioned to support business units in the planning and delivery of large-scale programs and projects. The Shared Services team within the ePMO operates as a center of excellence for portfolio management, and will provide leadership and support in ensuring the ePMO leverages project management best practices when initiating projects, and while monitoring and reporting the status of those projects to project and business leadership. Under the general direction of the Manager, and following best practices based on BABOK and other authoritative bodies, the Solutions Analyst is a critical thinker who is responsible for eliciting, analyzing, communicating, testing and verifying functional and non-functional business requirements for strategic initiatives, assisting with the definition of Acceptance Test Criteria, and ensuring requirements are specific, testable, and in alignment with business goals and architecture. This position will work with business and technology resources to temper and align preferences to develop collective and valuable solutions to business needs.
Duties
Leads analysis and requirements gathering sessions using methodologies such as JAD, JAR, SCRUM, etc., to define, analyze, and document business needs and requirements in support of strategic initiatives. Documents functional and non-functional business needs and requirements, ensuring requirements are usable, specific and testable, and in alignment to business goals and overall business architecture. Assists in defining Acceptance Test Criteria , tracing back to documented business requirements. Follows defined best practices for the organization based on BABOK or other authoritative bodies of knowledge. Creates and updates as-is and future state business workflows to enable the documentation of business process needs and production of requirements for all related business, and operational systems critical to the project or program. Makes recommendations for solutions or improvements that can be accomplished through new process or technology, or alternative uses of existing processes or technology. Researches and analyzes data in support of business functions, process knowledge, and systems requirements. Tracks maintenance of business need and requirements to ensure they are not attenuated or discarded during the execution and delivery phases. Supports the Project Manager by providing more detailed project objectives; clear structured, and useable requirements; tradeoff analysis; requirement feasibility; and risk analysis to improve the execution of the project plan. Conducts analysis in support of the entire ePMO. Perform other duties as assigned.
Education Required
Bachelor's Degree in Related Field
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Master's Degree in Related Field
Required Experience:
The position requires extensive business requirements writing experience
Minimum of 5 years of experience eliciting and documenting business and systems requirements using techniques such as JAR/JAD, SCRUM, etc. OR minimum of 5 years of experience developing, implementing, and evaluating workflow processes, policies, and procedures. Minimum of 7 years of experience in managed healthcare environment with strong domain expertise in at least one of the following disciplines: Claims/EDI, Membership, Provider, Care Management, or Finance .
Preferred Experience:
Experience with JIRA, Confluence, Tableau and Requirements Management software.
Skills
Required:
Proven ability to work with a diverse group of people, including leadership, support staff, coworkers and department management. Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others. Demonstrated critical thinking and problem solving skills. Strong elicitation and process documentation skills. Strong organizational and communication skills to build and foster effective relationships. Excellent computer skills; MS Office Suite (Word, Excel, Visio, PowerPoint) skills required. Excellent customer service skills with the ability to make independent judgments, handle multiple projects simultaneously, adapt to shifting priorities and utilize time management skills to meet deadlines. Must have excellent written and verbal communications skills and the ability to communicate effectively with management and non-management personnel. Ability to maintain a professional and mature demeanor at all times. Ability to work in a fast-paced department independently or in a team, and handle multiple tasks with competing priorities; work with interruptions and deal effectively with confidential information.
Senior Financial Analyst (Managed Care) - Hybrid
Posted 5 days ago
Job Viewed
Job Description
**Grow your career at Cedars-Sinai!**
Cedars-Sinai Medical Center has been named to the Honor Roll in U.S. News & World Report's "Best Hospitals " rankings . When you join our team, you'll gain access to our groundbreaking biomedical research facilities and sophisticated medical education programs. We offer learning programs, tuition reimbursement and performance-improvement projects so you can achieve certifications and degrees while gaining the knowledge and experience needed to advance your career.
We take pride in hiring the best, most hard-working employees. Our dedicated doctors, nurses and staff reflect the culturally and ethnically diverse community we serve. They are proof of our dedication to creating a dynamic, inclusive environment that fuels innovation and the gold standard of patient care we strive for.
**What will you be doing:**
The Senior Financial Analyst is responsible for assisting with the development, design, maintenance, coordination and implementation of reporting systems for business operations and management. Responsibilities include, but are not limited to, accessing data through a variety of databases and the creation of accurate, meaningful and relevant reports for diverse audiences; assisting with the administration and implementation financial initiatives; assisting in the interpretation of policies/procedures/practices.
Managed Care Reporting:
+ Prepare reports and presentations to communicate financial findings and recommendations to senior management.
+ Conduct financial modeling and forecasting to assess the impact of proposed contract changes and new initiatives.
+ Monitor and evaluate contract performance and financial metrics, identifying trends, variances, and areas for improvement.
+ Analyze managed care contracts for compliance and financial performance, identifying areas for optimization.
+ Generate regular and ad-hoc financial reports, summarizing key data, trends, and recommendations for decision-makers.
+ Lead complex or special assignments related to managed care financial analysis.
+ Provide analytic support across various departments and service lines, ensuring data-driven decisions.
+ Research and resolve inquiries related to assigned functional areas, offering strategic recommendations.
+ Collaborate with finance teams and management to review financial information and forecasts.
+ Apply federal and state regulatory requirements, as well as organizational policies and procedures, to all projects.
**Qualifications**
**Experience Requirements:**
Five (5) plus years of experience in reviewing and interpreting patient medical records using CPT and ICD10 coding systems.
Technical understanding of Healthcare Data systems is needed. Knowledge of electronic health records (EHR), claims data, and health information systems (e.ge., Epic, Cerner); Familiarity with ICD-10, CPT, and HCPCS codes, as well as other coding standards in managed care.
**Education Requirements:**
Bachelor's degree in Finance, Accounting, Healthcare Management, or related field of study
**Req ID** : 6681
**Working Title** : Senior Financial Analyst (Managed Care) - Hybrid
**Department** : MNS Accounting
**Business Entity** : Cedars-Sinai Medical Center
**Job Category** : Patient Financial Services
**Job Specialty** : Revenue Integrity
**Overtime Status** : EXEMPT
**Primary Shift** : Day
**Shift Duration** : 8 hour
**Base Pay** : $81,868.80 - $126,900.80
Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.