Professional, Behavioral Health, Facilities & Hospital Contracts Analyst
Status: Full-time, Exempt: Yes
This position supports the team that negotiates and manages contractual arrangements with the health plan’s participating behavioral health and substance abuse facilities and regional hospitals, hospital systems, and certain medical groups. Responsibilities include managing logistics of the provider contract process and preparation of standard and ad-hoc analyses / reports in support of contract and pricing initiatives. Provider contracting responsibilities include but are not limited to: preparation and coordination of documentation for network filings, product expansions, contract updates, and amendment mailouts, and serving as a key contact person for internal and external customer inquiries re: contract / business and payment inquiries. Maintains a facility database of contracts, due dates, term clauses/end dates, spend and services by LOB. Orders necessary data analytics from Informatics to support key business objectives, as needed. Runs reports through available on-line reporting tools to facilitate analysis of issues and requests. Maintains necessary tracking system for department and company report outs. Candidate will engage external providers on specific contract items so that MVP is communicating consistently within accepted timetables with the contracted network. Dataflow requests: completes comprehensive data forms for tracking, forms to CFO for signature and forms to BSC for system configuration. Requires financial understanding of contract impact and changes against budgeted targets. Handles follow-up inquiries regarding new agreements. Validates quarterly HPN deficiency reports and provider directories. Maintains databases: Network facility and system data tables, contract rate due dates, MVP spend at each facility by LOB, list of contract negotiations. Coordination and tracking of mailings: Represent department in various workgroups. Performs other duties as assigned, handling frequent network requests from Network Management leadership. Analytics responsibilities include: independent structuring of studies including initial evaluation of requests, extraction of data from warehouse using identified standard set of tools, and production of high quality, professional reports for distribution. Reports to be produced include claim reports, variance analyses, and supplemental drill-down reports. Must be able to prepare visual aids (charts, graphs) or summaries to assist with explanation of the findings. Must also provide adequate documentation of how analysis was performed and be responsible for applying necessary checks and balances to ensure quality and accuracy or report.
Minimum Education: Bachelor’s Degree or comparable combination of education and related work experience required.
Minimum Experience: One to two years’ work experience in an analytical environment with problem solving responsibilities. Required Skills: • Working knowledge of relational databases including querying and reporting. Experience developing Excel/Access applications. • Ability to organize and present data effectively; detail oriented. • Ability to work independently and prioritize to meet deadlines; internal and regulatory. • Strong organizational, time management, oral, written and communication skills. • Must have a high degree of personal initiative and able to work independently. • Knowledge of terms, conditions and rate components of a facility agreement. • Knowledge of technical contract reimbursement by lines of business: Medicare, Medicaid and Commercial. • Ability to work cooperatively with other MVP internal departments. • Must have reliable transportation, willing to travel occasionally throughout MVP’s service areas, with overnights as required. • Excellent computer skills including working knowledge of Microsoft Office suite – Word, Excel, Outlook, PowerPoint, and Access. Preferred Skills: • Working knowledge of Facets claims payment system. • Experience in hospital and physician reimbursement and network expansion on all lines of business (Commercial, Medicare and Medicaid). • Prior work experience in contract coordination/management within NYS and across state lines. • Must be self-organized and disciplined, a self-starter understanding workflow, processes and due dates. Must be committed to staying on track.
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- Job Family Network Management & Development
- Pay Type Salary
- Binghamton Office, Endwell, New York, United States of America
- Headquarters Office, Schenectady, New York, United States of America
- Utica Office, Utica, New York, United States of America