Business and Information Analyst - Provider Contracting - Full Time - Days
At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest.
Our mission is to improve your health and well-being. So we’re committed to your wellness with various initiatives, such as preventive services, online knowledge, health risk assessments, our Steps2Health disease management programs, health fairs, and more.
The Business and Information Analyst creates and maintains provider information and roster files; also assists with fee schedules and associated reimbursement changes. Along with creating and maintaining provider data files and fee schedules, this position assists in communication with other department staff on quality assurance needs. As well as communication with other departments on needed fee schedule and provider data file updates. This position also supplies data to other departments as needed. This position reports directly to the Manager of Provider Contracting and Network Management. No positions report to this position.
1. Creates and maintains accurate provider data files reflecting hospital, ancillary and professional rosters.
2. Ensures that provider data files are updated in a timely manner to establish accurate reimbursement in accordance with provider contracts.
3. Assists with building and evaluation of provider reimbursement schedules as needed. Ensure accurate and timely implementation of provider reimbursement schedules while coordinating with other departments to ensure fee schedule accuracy.
4. Completes financial impact analysis reports having anything to do with fee or rate changes. By use of Cognos and Truven analytical tools.
5. Assists with the calculation of annual rate revisions based upon each provider’s charge increase and charge increase maximum.
6. Work cooperatively with other departments on review of claim issues, pended claims, and related operations tasks.
7. Assist management team with negotiating case rates as needed.
8. Assists with the development, implementation, and maintenance of action plans and assists with efforts to implement network-pricing strategies.
9. Utilize AMISYS, Truven and Cognos analytic applications as needed to review network and claim
10. Complete data requests for Marketing RFP processes related to fee schedules.
11. Ability to capture and analyze regional and national PPO data monthly for standard reports.
12. Handle day to day inquiries regarding hospital or physician payments; Research as appropriate.
13. Accurately load data and run reports using Microsoft Excel and Access, as well as Cognos and Truven analytical packages.
14. Complete projects as assigned by the management team.
15. Perform other duties as directed.
1. Bachelor’s degree preferred (equivalent work experience will be considered by management team), in healthcare or business related field with 1-3 years relevant work experience in developing and understanding provider reimbursement schedules.
2. Knowledge of Cognos and Truven applications is a plus.
3. Excellent written, verbal, and organizational skills required.
4. 1+ year business experience required; experience in a hospital or insurance industry strongly preferred.
5. Demonstrated understanding of DRG, CPT, UB, ICD10 coding concepts, and medical benefit payment systems required.
6. Experience in automated information systems and hands-on experience using computers for Microsoft Excel spreadsheet applications required.
7. Experience with Microsoft Access database and Microsoft Word processing applications and end-user reporting required. Knowledge of AMISYS claim adjudication software is a plus.
8. Ability to communicate on telephones; operate comput
ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact firstname.lastname@example.org
Equal Opportunity Employer/Drug-Free Workplace
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