Managed Care Analyst

Description

AdaptHealth Opportunity – Apply Today!

At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives – out of the hospital and in their homes. We are actively recruiting in your area. If you are passionate about making a profound impact on the quality of patients’ lives, please click to apply, we would love to hear from you.

Managed Care Analyst

The Managed Care Analyst is responsible for contract management for which AdaptHealth is negotiating and entering. Demonstrates expert knowledge about the details and benefits of contracts, as well as potential disadvantages. Assists with contracting projects.

Job Duties:

• Collaborates with Payer Engagement Team to negotiate provider agreements with health plans.
• Reviews all payer contracts, agreements, and amendments thoroughly and with a high level of detail to ensure all terms and language are aligned with established standards.
• Communicates with Credentialing Team of needs for new contracts and changes needed to existing contracts.
• Collaborates with business development to draft, review, and execute facility agreements.
• Aids in negotiations for special payment arrangements with health plans and facilities.
• Focuses on preferred and exclusive arrangements nationwide in partnership with Payer Engagement Team.
• Ensures current master agreements, announcements, and provider manual updates on SharePoint.
• facilitate new contracts and/ or payer changes are shared with appropriate parties to ensure accurate and timely set up in the system.
• Distributes updates to applicable departments within AdaptHealth.
• Assists with negotiating, coordinating, and outreach for single case agreements while verifying payments have been applied correctly to patient accounts.
• Maintains Master Contracting Log.
• Monitors contract renewal dates and communicates with Payer Engagement Team to reaches out to payers to set up meetings when contracts are up for renewal.
• Assists Senior Director or Payer Engagement Team with contract negotiations, agreements, and other contracting projects as needed.
• Coordinates with Managed Care Directors, payors, Sales, to organize meetings and enhance communications.
• Assists with developing and analyzing patient census, fee schedule and utilization reporting for contract negotiations.
• Conduct analysis on amendments received to compare and identify the changes and impact.
• Review requests from sales, operations and directly from payers with Payer Engagement to establish plan of pursuing the contract.
• Follow up on contracts once signed to obtain dually executed copy and ensure payer set up completion and load and effectively communicate outcomes to appropriate parties.
• Reaches out to payers for fee schedule and coding updates and to address questions as needed.
• Contacts payers regarding pricing discrepancies and works to resolve the discrepancies as needed.
• Coordinates and assists billing and other areas to resolve claim problems with payors as needed.

Competency, Skills and Abilities:

• Independent thinker and decision maker
• Strong analytical and problem-solving skills with attention to detail
• Job Title: Managed Care Analyst FLSA Classification: Exempt
• Department: Contracting Rev Date: 9/20, 01/21
• Reports To: Senior Director, Managed Care Approved by: Human Resources
• Excellent verbal and written communication
• Excellent customer service skills
• Proficient computer skills and knowledge of Microsoft Office specifically Excel
• Ability to prioritize and manage multiple projects.
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.

Requirements

Minimum Job Qualifications:

• Bachelor’s degree from an accredited college required.
• Five (5) years contracting, business development, or network management experience required.

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.