UCSD Layoff from Career Appointment: Apply by 10/10/2019 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Special Selection Applicants: Apply by 10/21/2019. Eligible Special Selection clients should contact their Disability Counselor for assistance.
Reporting to the Provider Network Contracts Manager, the Managed Care Contract Analyst compiles, validates, and analyzes healthcare cost, quality and utilization data to aid in contract negotiations as well as contract performance and network enhancement initiatives. In addition to gathering volume data and modeling of current reimbursement, the Managed Care Contract Analyst determines the need for reimbursement methodology changes and proposes target rates.
Responsibilities include: Provides support for special projects, which includes collecting, analyzing and modeling of claim data in preparation for provider contract negotiations. Prepares and analyzes physician practice reimbursement utilizing appropriate rates based on contract structure, place of service, provider and modifiers for each CPT code. Calculates Medicare reimbursement and compares to payer reimbursement for same volume.
In collaboration with Network Contracts Manager, responsible for all aspects of Provider Negotiations including contract language review to negotiate language with providers to ensure favorable terms. Responsible for Contract Finalization and Implementation including the review of final documents to ensure accuracy upon agreement terms, return of countersigned documents to provider, communication of any pertinent changes throughout the system, and an audit of the contract build 3 months post implementation. Negotiates single case agreements for all entities as needed. Logs single case agreement and communicates such agreement to appropriate staff.
Independently analyzes, researches, and recommends resolution for contract disputes, non-routine claim issues, billing questions, and other practices. Communicates and assists with identification and implementation of issue resolution. Ensures issues are handled appropriately and professionally in accordance with payor and regulatory requirements. Data extraction for various reports and analyses upon request.
Works independently on multiple tasks, sets priorities, and develops comprehensive timetables and strategies to meet numerous and constantly changing deadlines. Leads Contract Implementation Workgroup. Collaborates with Network Contracts Manager to build and maintain cost effective, accessible provider network. Manages and maintains provider contracting database to ensure current, accurate ancillary, facility, and physician demographics and contract detail, and initiates database improvements.
Bachelor's Degree in related area; and/or equivalent experience/training.
A minimum of two (2+) or more years of relevant experience.
Experience and proven success in managed care contracting, contract review, tracking, and maintenance.
Proficiency with MS Office (Excel, PowerPoint, Word) required. Knowledge of Excel, including VLookups and Pivot Tables.
Demonstrates analytical, problem solving, and critical thinking skills.
Strong organizational and written/oral communication skills.
Ability to work in a fast paced and changing environment. Excellent ability to manage to deadlines.
Asana and programming experience.
Must be able to work various hours and locations based on business needs.
Employment is subject to a criminal background check and pre-employment physical.
UC San Diego is an academic powerhouse and economic engine, recognized as one of the top 8 public universities by U.S. News and World Report. Innovation is central to who we are and what we do. Here, students learn that knowledge isn't just acquired in the classroom - life is their laboratory. UC San Diego's rich academic portfolio includes six undergraduate colleges, five academic divisions and five graduate and professional schools. The university's award-winning scholars are experts at the forefront of their fields with an impressive track record for achieving scientific, medical and technological breakthroughs.