Senior Operations Analyst Managed Care

Job Description

The Senior Operations Analyst Managed Care reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Senior Operations Analyst is responsible for acting as the liaison between the contracting team and internal departments to operationalize the contract. Additionally, the Sr. Operations Analyst supports and assists the Director, Managed Care in planning and day to day implementation regarding key tactics which support the Hospital’s managed care strategy.

Responsibilities:

Supervises and governs the Payer Plan code assignment process for all managed care contracts, including government and special project contracts. Including working with key internal operational areas, NM IS, and Finance to vet out and properly map codes for accurate financial reporting.

Works with multiple operations departments including Revenue Cycle, Information Systems and Access, to implement the operations of the managed care, government and special project contracts, as well as any major administrative payer requirements that have a material financial impact.

Works in conjunction with NM IS to help lead and manage changes affecting the Epic patient accounting system.

Ensures Payer contracts are loaded correctly into the NM system and in a timely matter and approves the testing of the reimbursement functions.

Collaborate with Epic Application Analyst to understand and load contract logic within the Epic patient accounting system to calculate expected reimbursement accurately on billed charges, which will directly affect Accounting/Finance tasks.

Develops and maintains validation process for loading the contract logic within the Epic patient accounting system.Contract load as it relates to: New Contracts, Amendments, Annual Escalators, Fee Schedule Updates and Price Increase (Annually with Managed Care Analyst team)

Responsible for the distribution of all-important contracting documents to appropriate parties.Supporting the annual Internal Audit with Ernst & Young

3M Liaison for Government Pricing

Responsible for supporting various departments through the escalation of tickets through the Service Now portal based on the appropriately assigned payor and/or category.

SharePoint Administrator

Create reimbursement tools with all managed care contracted rate schedules by region for the patient accounting teams to utilize when following up on managed care accounts.

Researches and works out resolution on contract load issues resulting in discrepancy of payment.

Participates in regular meetings with the vendor in maintaining and updating the insurance on demand tool. Continuously provides feedback and recommendations for a better end user experience that provides an efficiency and ease of navigating the tool.

Continuously monitors Real Time Eligibility Application and payor plan mapping within the Epic patient accounting system to ensure accuracy and proper function for all hospital and office access points where patient eligibility information can be obtained quickly and easily as to not to disrupt workflows and patient satisfaction.

Supports Epic Systems Integrations

Collaborates on and executes on special projects and duties as assigned by the Manager and Director, Managed Care.