Senior Managed Care Reimbursement Analyst

At Franciscan, our Senior Managed Care Reimbursement Analysts work with the Facility Information Systems and Health Information Management to extract the data necessary to perform ongoing analysis of all account-based, reimbursement transactions for accuracy. The position analyzes Facility Managed Care contracts, reconciles to payments received, and makes recommendations to prevent future cash losses.

WHO WE ARE

Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. With 11 ministries and access points across Indiana, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers who provide compassionate, comprehensive care for our patients and the communities we serve.

WHAT YOU CAN EXPECT

• Support the System’s reimbursement strategies and initiatives through analysis of performance objectives and assessment of changes necessary for migration from a fee-for-service reimbursement to a risk-based reimbursement/capitation environment.

• Management of reports to monitor variances between managed care contracts, compare expected reimbursement rates by site and service, and benchmark to other payment rates (e.g. Medicare).

• Develop financial and planning models to evaluate the impact of proposed reimbursement initiatives, contracts, amendments, payment disputes, and changes in regulation or provider manuals.

• Perform reimbursement modeling for new strategic projects or services and with managed care contract scenario modeling.

• Conduct the strategic reimbursement modeling to support changes to the charge master.

• Access rate schedules, product details, and historical claims to build and deploy model scenarios. Leverage multiple data points to provide visibility into all key model components.

• Synthesize data, opportunities, issues/challenges, and articulate findings, conclusions, and recommendations.

QUALIFICATIONS

• Bachelor's Degree Business, Statistics, Information Systems, Healthcare Management or related - Required

• Master's Degree Business, Statistics, Information Systems, Healthcare Management or related - Preferred

• 7 years Reimbursement/Analyst - Required -AND-

• 5 years Healthcare Managed Care Modeling - Required

• EPIC Certified or Accredited - EPIC obtained within 180 days - Required

TRAVEL IS REQUIRED:

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.