Managed Care Analyst - Managed Care

  • Adventist Health System
  • Maitland, FL, USA
  • Jan 21, 2018

Job Description

If you want to be a part of a place that provides nothing less than extraordinary compassionate care, then Adventist Health System is the place for you!

We are currently seeking qualified candidates for a Managed Care position that will be based in our Managed Care department. This position is based in Maitland, FL.

The Managed Care Analyst applies technical, analytical, and problem-solving skills to provide solutions/improvements within the department. Responsible for completing financial and/or operational analysis of contracts, developing and tracking key performance indicators, financial modelling comparative analysis and bench marking. This person demonstrates competences in decision support and reporting through converting raw data into useful and actionable information. This person is responsible for compiling and analyzing data as well as for creating meaningful applications to support executive decision making. Character traits include: strong work ethic, trainability, communicative, team player all with a positive "can do" attitude. Intermediate Excel skills required.

Job Duties :

  • Supports Managed Care leadership in financial modeling.
  • Basic knowledge of contractual language as it relates to reimbursement methodologies
  • Applies basic understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and revenue codes
  • Demonstrates knowledge of various reimbursement methodologies including, Per Diem, DRG, fee schedules, and percent of charge
  • Demonstrates knowledge of commercial payers for modeling and analyzing contract proposals
  • Performs analytical and planning functions in support of Managed Care decision making
  • Participates in the annual Managed Care revenue budget process
  • Utilizes a variety of software applications and data sources to produce the Managed Care Suite, DAA reports, other standard reporting, and adhoc reports
  • Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance
  • Supports Senior Managed Care Analyst in timely and efficiently completing financial analyses related to Managed Care net revenue.
  • Completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by Leadership
  • Adapts to new situations and changing priorities to accomplish project deadlines and department goals
  • Demonstrates strong project management and organizational skills by maintaining up-to-date project lists to assist in setting appropriate project priorities
  • Applies technical expertise in the development of models and decision support information
  • Assures the application of appropriate standards of data analysis and that all analytics are quality checked
  • Develop an understanding of reimbursement methodologies and their impact on internal systems and other departments
  • Fully documents the process required to replicate any analytic process undertaken
  • Contributes to the overall completion of the work product in group project situations
  • Maintains and utilizes available resources to ensure work is completed accurately and timely
  • Displays a willingness to grow and develop skills required to perform his/her job duties
  • Takes the initiative to seek out education and training to stay informed of changes in the field of managed care
  • Participates in meetings as assigned or requested
  • Communicates problems and recommends solutions to Finance Manager
  • Adheres to applicable internal policies, procedures, and guidelines as set forth by Adventist Health Systems, its associated hospitals, physician groups, PHOs and ancillaries during the execution of assigned duties
  • Abides by all applicable rules, regulations, and laws prescribed by any authoritative governing body such as the State of Florida, AHCA, etc.
  • Does not interfere with the ability of co-workers to complete their duties


  • Microsoft Office (Excel PowerPoint, Word, Outlook, Visio, etc.)
  • Excellent verbal and written communication skills
  • Excellent problem solving skills
  • Healthcare information systems (PCON, Cerner, Soarian) (Preferred)
  • Business Intelligence Software (Qlikview, Tableau, SAP, etc.) (Preferred)
  • Data warehousing tools (SQL Server, etc.) (Preferred)
  • Microsoft Visual Basic/Access (Preferred)
  • Financial Reporting and Analysis (Preferred)

Education and Experience Requirement:

  • Associates Degree in Business, Accounting, Finance, Information Systems, or related.
  • 1-3 years of experience in managed care, patient billing services, health insurance claims processing, contract management, finance, or accounting.
  • Bachelor's degree in Business, Accounting, Finance, Information Systems, or related. 3 years experience in managed care finance. (Preferred)


  • Achieves Results: Reflects a drive to achieve and outperform, continuously looking for improvements, and accepts responsibility for actions and results
  • Builds and Shares Knowledge: Develops and shares subject matter expertise/reusable assets that can be readily applied to new tasks
  • Communication Skills: Exhibits excellent oral and written communication skills
  • Critical Thinking: Methodically analyzes and evaluates business problems by defining the challenges, identifying alternatives, and making timely decisions
  • Develops Self: Understands own strengths and development needs, learns from experience, and owns personal development
  • Manages and Executes Projects: Manages all aspects of engagement/project to ensure outcomes and timing are met
  • Problem Solving: Identifies and solves problems using data collection methods, analysis, experience, and judgment
  • Service Orientation: Listens to and understands the customer, anticipates customer needs, and gives high priority to customer satisfaction
  • Manages to Results: Contributes to the successful realization of goals and demonstrates accountability for goal realization
  • Subject Matter Expertise: Possesses deep knowledge and specialized skill set pertaining to the job function

If this position sounds like a great match for your skills set and experience, please apply online now !