Managed Care Analyst

Remote, | Corporate Operations

Position Summary:

At GoHealth Urgent Care, we place the needs of our patients first - by providing an effortless patient experience, a welcoming culture of care and seamless integration with market-leading health systems and our communities.
 
Reporting to the Director, Value Based Care, the Managed Care Analyst (Analyst) is responsible for analysis of all current and future payor contract terms, including gathering, storing, and maintaining performance data to support all payor negotiations. The Analyst will use contract terms and performance data to model scenario-based impacts by payor product to help support and inform contracting strategy and negotiations. In addition, the Analyst will act as a liaison with our joint venture partners to request, track and add payor updates to produce rate-trend forecasting/budgeting/reporting models and partner with finance, accounting, central business office and operational teams to distribute and educate on the related data and findings/information.
 
The Analyst will conduct research on new government healthcare reimbursement and regulations changes (including commercial payor policy changes) and lead communication and coordination with operational teams and the central business office for both required and opportunity implementation.Additional support to prepare and coordinate managed care meetings with payors and health system partners to provide consistent, accurate data and presentations.
 
Candidate Qualifications:
 
  • BS or BA degree in related field. Master’s degree preferred. (MHA, MPH, MBA
  • Completed coursework in statistics or demonstrated working knowledge of statistical presentation/interpretation of data required
  • 1 year of work experience in healthcare finance, economics, or managed care.
  • Advanced Microsoft Excel and PowerPoint skills
  • Working knowledge of SQL or other programming language (SAS, R, SPSS, etc.) preferred
  • Working knowledge of relational databases, healthcare industry code systems (ICD, CPT, NDC, etc.), and discrete data management concepts required/highly preferred?
  • Ability to work independently.
  • Ability to think creatively, highly driven, self-starter.
  • Exceptional attention to detail and analysis quality/accuracy.
  • Excellent analytical skills.
Candidate Responsibilities:
 
  • Lead analysis of all current and future payor contact terms to support new negotiations or renewals, including gathering, storing, and maintaining performance data on denials, patient and payor collections, remittance timing and other key indicators.
  • Gather performance data and model scenario-based impact by product to help support and inform commercial strategy.
  • Request, track and maintain payor contract amendments, renewals, and expansion of service scope to share with internal finance, accounting, and central business office departments.
  • Act as a liaison with our joint venture partners to produce rate trend forecasting/budgeting/reporting models and partner with finance, accounting, and operational teams to distribute related data and information.
  • Conduct research and new government healthcare reimbursement and regulations changes and lead communication and coordination with operational teams and revenue cycle for proper implementation. Similarly, track and distill changes communicated by commercial insurance payors through bulletin, policy, and other means and both update the internal teams and analyze the financial impacts of such.
  • Prepare and coordinate managed care meetings with health system partners to provide consistent, accurate data and presentations.
  • Lead managed-care initiatives and support related managed-care data requests from our joint venture partners, inquires from payors and other entities.
  • Support new joint venture partner development, including payor information and contract terms to compare and model opportunities.
  • Other duties as assigned.
UPDATE: COVID Vaccine Announcement: GoHealth Urgent Care is requiring all new hires to disclose their COVID-19 vaccination status in all markets. In certain markets, it will be required that new hires be fully vaccinated and boosted for COVID-19 vaccine (either the Moderna or Pfizer vaccine series or the single dose Johnson & Johnson Janssen vaccine) prior to their first day of employment. This is a condition of employment, unless a faith-based or medical exemption is approved.

All qualified persons are granted an equal opportunity for employment without regard to race, color, religion, sex, sexual orientation and gender identity or expression, age, national origin, citizenship status, disability, genetic information, medical condition, family care leave status, pregnancy or pregnancy-related condition, otherwise qualified disabled or veteran status. The company will comply with all fair employment laws in each of the jurisdictions where we conduct business.


Keywords:
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Why GoHealth?

GoHealth Urgent Care has outstanding career opportunities in Connecticut, Delaware, Houston, Maryland, Michigan, Missouri, New York City, North Carolina, Northwest Arkansas, Oklahoma City, San Francisco and the Portland-Vancouver area. And all of these positions have one thing in common: flexibility to practice urgent care medicine the way it was meant to be, without the stress and bureaucracy of hierarchical organizations. With reasonable work hours that don’t emotionally exhaust or burn them out, our team can balance and prioritize their professional and personal lives.