Managed Care Analyst Senior

Under general supervision of the Vice President of Managed Care, the Senior Managed Care Analyst develops, directs and/or performs analytical and planning functions in support of managed care decision making. Proactively identifies areas of opportunity with regard to reimbursement for the hospital and practitioners. Integrally involved in Managed Care contract functions including analysis of contract language and rate structure, and maintenance of contractual agreements that require updating through system programming. Responsible for internal distribution of data and provides other support as needed in the Managed Care department. Interacts interdepartmentally on operational issues associated with rate implementation and payment variances. Maintains knowledge and understanding of the current developments in the healthcare industry to include: service delivery, reimbursements, compliance/regulations, policies and procedures of Governmental and Commercial payers. Responsible for performing job duties in accordance with mission, vision and values of Tampa General Hospital.

Essential Functions:

• Directs and/or performs analytical and planning functions in support of managed care decision making.
• Develops and implements decision support strategies into decision support, contract management, and data management systems.
• Analysis of contract language and rate structure, and maintenance of contractual agreements that require updating through system programming.
• Loads contract rates into the contract modeling systems and audits entries to verify expected net revenue financial output is calculating correctly.
• Understands and writes system programming specifically for the purpose of loading contract rates into contract management systems.
• Educates and communicates contract changes interdepartmentally through distribution of detailed matrixes, summarizations, data entry into database applications, and use of other communication and tracking tools, to include maintaining transplant and physician grids.
• Extracts data from the decision support systems and provide analysis of data.
• Maintains knowledge and understanding of the current developments in the healthcare industry.
• Completes numerous and varied financial projects for the Managed Care and Finance Divisions.