45 Unitedhealth Group jobs in Fullerton
Managed Care Compliance Specialist - Managed Care
90079 Los Angeles, California
Cedars-Sinai
Posted 3 days ago
Job Viewed
Job Description
Job Description
The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Duties and Responsibilities:
-
Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.
-
Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.
-
Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.
-
Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.
-
Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.
-
Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.
-
Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.
-
Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.
-
Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.
-
Remains updated on all member and provider policy changes made by the health plan and/or the State.
-
Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.
-
Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.
Qualifications
Education:
High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.
Experience:
Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.
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.
About the Team
With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.
Req ID : 11981
Working Title : Managed Care Compliance Specialist - Managed Care
Department : MNS Managed Care
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 : $34.69 - $53.77
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.
View Now
0
Managed Care Compliance Specialist - Managed Care
90006 Los Angeles, California
Cedars-Sinai
Posted 2 days ago
Job Viewed
Job Description
**Job Description**
The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Duties and Responsibilities:
+ Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.
+ Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.
+ Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.
+ Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.
+ Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.
+ Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.
+ Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.
+ Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.
+ Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.
+ Remains updated on all member and provider policy changes made by the health plan and/or the State.
+ Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.
+ Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.
**Qualifications**
**Education:**
High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.
**Experience:**
Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.
**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.
**About the Team**
With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.
**Req ID** : 11981
**Working Title** : Managed Care Compliance Specialist - Managed Care
**Department** : MNS Managed Care
**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** : $34.69 - $53.77
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.
The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Duties and Responsibilities:
+ Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.
+ Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.
+ Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.
+ Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.
+ Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.
+ Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.
+ Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.
+ Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.
+ Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.
+ Remains updated on all member and provider policy changes made by the health plan and/or the State.
+ Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.
+ Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.
**Qualifications**
**Education:**
High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.
**Experience:**
Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.
**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.
**About the Team**
With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai's medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.
**Req ID** : 11981
**Working Title** : Managed Care Compliance Specialist - Managed Care
**Department** : MNS Managed Care
**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** : $34.69 - $53.77
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.
View Now
1
Revenue & Managed Care Analyst
91122 Pasadena, California
Martin Luther King, Jr. Community Hospital
Posted today
Job Viewed
Job Description
If interested, please apply and submit your resume to
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
POSITION REQUIREMENTS
A. Education
B. Qualifications/Experience
C. Special Skills/Knowledge
#LI-MM1
MLKCH Video
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.
B. Qualifications/Experience
- 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.
C. Special Skills/Knowledge
- 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.
#LI-MM1
MLKCH Video
View Now
2
Revenue & Managed Care Analyst
90660 Pico Rivera, California
Martin Luther King, Jr. Community Hospital
Posted today
Job Viewed
Job Description
If interested, please apply and submit your resume to
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
POSITION REQUIREMENTS
A. Education
B. Qualifications/Experience
C. Special Skills/Knowledge
#LI-MM1
MLKCH Video
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.
B. Qualifications/Experience
- 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.
C. Special Skills/Knowledge
- 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.
#LI-MM1
MLKCH Video
View Now
3
Revenue & Managed Care Analyst
90637 La Mirada, California
Martin Luther King, Jr. Community Hospital
Posted today
Job Viewed
Job Description
If interested, please apply and submit your resume to
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
POSITION REQUIREMENTS
A. Education
B. Qualifications/Experience
C. Special Skills/Knowledge
#LI-MM1
MLKCH Video
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.
B. Qualifications/Experience
- 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.
C. Special Skills/Knowledge
- 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.
#LI-MM1
MLKCH Video
View Now
4
Revenue & Managed Care Analyst
90248 Gardena, California
Martin Luther King, Jr. Community Hospital
Posted today
Job Viewed
Job Description
If interested, please apply and submit your resume to
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
POSITION REQUIREMENTS
A. Education
B. Qualifications/Experience
C. Special Skills/Knowledge
#LI-MM1
MLKCH Video
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.
B. Qualifications/Experience
- 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.
C. Special Skills/Knowledge
- 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.
#LI-MM1
MLKCH Video
View Now
5
Revenue & Managed Care Analyst
90715 Lakewood, California
Martin Luther King, Jr. Community Hospital
Posted today
Job Viewed
Job Description
If interested, please apply and submit your resume to
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
POSITION REQUIREMENTS
A. Education
B. Qualifications/Experience
C. Special Skills/Knowledge
#LI-MM1
MLKCH Video
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.
B. Qualifications/Experience
- 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.
C. Special Skills/Knowledge
- 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.
#LI-MM1
MLKCH Video
View Now
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6
Revenue & Managed Care Analyst
90607 Whittier, California
Martin Luther King, Jr. Community Hospital
Posted today
Job Viewed
Job Description
If interested, please apply and submit your resume to
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
POSITION REQUIREMENTS
A. Education
B. Qualifications/Experience
C. Special Skills/Knowledge
#LI-MM1
MLKCH Video
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.
B. Qualifications/Experience
- 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.
C. Special Skills/Knowledge
- 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.
#LI-MM1
MLKCH Video
View Now
7
Revenue & Managed Care Analyst
90637 La Mirada, California
Martin Luther King, Jr. Community Hospital
Posted today
Job Viewed
Job Description
If interested, please apply and submit your resume to
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
POSITION REQUIREMENTS
A. Education
B. Qualifications/Experience
C. Special Skills/Knowledge
#LI-MM1
MLKCH Video
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.
B. Qualifications/Experience
- 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.
C. Special Skills/Knowledge
- 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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8
Revenue & Managed Care Analyst
90255 Huntington Park, California
Martin Luther King, Jr. Community Hospital
Posted today
Job Viewed
Job Description
If interested, please apply and submit your resume to
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
POSITION REQUIREMENTS
A. Education
B. Qualifications/Experience
C. Special Skills/Knowledge
#LI-MM1
MLKCH Video
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.
B. Qualifications/Experience
- 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.
C. Special Skills/Knowledge
- 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.
#LI-MM1
MLKCH Video
View Now
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