Apply for Vacancy for Care Analyst at Weill Cornell Medicine in the USA. The deadline for this job is 30th September 2021.
Maximizes managed care reimbursement by preparing data for contract negotiations, auditing claims to identify non-compliance with contract terms and validating physician and fee schedules set up during contract implementation and amendment.
- Analyzes and audits a high volume of contracted managed care claims data to identify non-compliance with contract terms and improper linkage of physicians to Weill Cornell fee schedule.
- Also, analyzes proposed reimbursement rates for potential contract against industry standards and internal criteria.
- Additionally, assists in providing training on processes and procedures to maximize reimbursement.
- Likewise, assists in validating and maintaining contracting terms, and contract coding and setup in Contract Management module.
- Develops and maintains complex queries and reports that combine multiple sources of data.
- Identifies trends in payments errors and payment policies to increase reimbursement.
- Furthermore, prepares monthly ad hoc reports on managed care contract compliance and recovery activities for PO physicians based on paid data from applying criteria from managed care plan payment policies and other industry standard criteria.
- Similarly, serves as a liaison with managed care organization representatives to facilitate the explanation or resolution of questionable claim adjudications based on plan EOBs or other documentation.
- Additionally, verifies accuracy of fee schedules for contracted managed care plans by product and geographic region and distributes fee schedule and information about specific codes to PO business office, physicians, administrators and voluntary faculty.
- Bachelor’s Degree in related field
- Approximately 2 years of related work experience.
Knowledge, Skills and Abilities
- Proven analytical skills including the ability to analyze data from various sources and identify errors.
- Also, advanced knowledge of Microsoft Excel and Microsoft Access including the ability to create pivot tables; perform V-lookups, manipulate data, create formulas to analyze information and import and export data between Excel and Access.
- Proficiency using Microsoft Word.
- Likewise, effective organizational and time management skills, including the ability to meet deadlines and function effectively in a high volume work environment.
- Furthermore, good interpersonal skills, including the ability to interact effectively with various constituencies.
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