Payer Contract & Reimb Analyst Job Listing at Lexington Medical Center in West Columbia, SC (Job ID 1266575900)

Description

Managed Care & Payer Relations  
Full Time
Day Shift 
8

Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in South Carolina and the first hospital in the state to achieve Magnet with Distinction status for excellence in nursing care.

The 607-bed teaching hospital anchors a health care network that includes six community medical centers and employs more than 8,700 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina's first HeartCARE CenterTM and an accredited Cancer Center of Excellence affiliated with MUSC Hollings Cancer Center for research and education. The network also features an occupational health center, the largest skilled nursing facility in the Carolinas, an Alzheimer's care center and nearly 80 physician practices.  Its postgraduate medical education programs include family medicine and transitional year.

Administers all functions related to the Managed Care Department's contract management system including maintaining data feeds from hospital and physician practice source systems to payer contract management systems, maintaining payer rate schedules within the contract management system, and developing key financial tracking reports.

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 8 Years of healthcare experience in finance or manage care environment
Substitutable Education & Experience: 8 Years of experience can be substituted for a Bachelor's degree in a business related field and 3 years of experience in healthcare/finance/managed care environment
Required Certifications/Licensure: None.
Required Training: Knowledge of relational database systems;
Experience in database, spreadsheet, and word processing applications;
Working knowledge of managed care reimbursement methodologies (i.e. DRG, per diem, fee schedule, APC);
Procedural knowledge of hospital and physician practice accounts receivable management;
Working knowledge of billing/coding terminology (i.e. ICD-9, CPT, Revenue codes).

• Coordinate and interact with Information Services for data abstraction, including providing requirements relating to data retention.
• Identify problems and issues with database; develop and implement strategy to resolve problems.
• Assist Director in loading Inpatient and Outpatient contract terms and rates for negotiated managed care contracts.
• Provide technical support and training for staff including coordinating problem resolution with IS and direct Supervisor.
• Ensure data integrity of import data, data files, and backup files.
• Assist Manager and Director in contract modeling and analysis of proposed reimbursement rates and other financial terms.
• On an ongoing basis, measure the performance of negotiated rates.

• Analyze reimbursement to identify negotiation opportunities.
• Create and maintain a comparative reimbursement database.
• Provide monthly financial performance reports for each managed care contract.
• Provide monthly managed care revenue reports.
• Analyze and determine the reimbursement impact when large Groups shift from one managed care plan to another.
• Create and maintain a centralized managed care recoveries database.
• Conduct service line managed care reimbursement analysis as requested by Administration/Management.
• Performs all other duties as assigned.

We are committed to offering quality, cost-effective benefits choices for our employees and their families:

• Day ONE medical, dental and life insurance benefits 
• Health care and dependent care flexible spending accounts (FSAs)
• Employees are eligible for enrollment into the 403(b) match plan day one.  LHI matches dollar for dollar up to 6%.
• Employer paid life insurance – equal to 1x salary
• Employee may elect supplemental life insurance with low cost premiums up to 3x salary 
• Adoption assistance
• LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
• Tuition reimbursement
• Student loan forgiveness

Equal Opportunity Employer
It is the policy of LMC to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. LMC strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. LMC endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee's desires and abilities and the hospital's needs.