Job Description Summary

South Shore Hospital, Southeastern Massachusetts's leading provider of emergency, acute, and outpatient care, is seeking a Managed Care Analyst to join our Managed Care team with our Integrated Delivery Network. This position offers a hybrid schedule, with work able to be conducted at our offices at 30 Reservoir Park Drive in Weymouth and remotely. Reporting to the Director of Finance and Analysis, the South Shore Hospital Integrated Delivery Network (IDN) Managed Care Analyst will work collaboratively with senior hospital and IDN management to plan and perform complex data analyses required for the development of new IDN programs that support the increased utilization of South Shore Hospital and SSPHO physician services, and will be responsible for defining and prioritizing the IDN’s analytic objectives.

Job Description

Responsibilities

• Analyze and provide high quality reporting of data and analytics that support any and all IDN initiatives
• Monitor the financial performance of managed care contracts; trending medical services utilization and cost management by contract for the IDN, and by physician; develop health plan quality reporting; and creating ad hoc reports as necessary
• Generate reports in a timely manner that inform IDN decision making on key business issues, fully documenting the process required to replicate any analytic undertaken
• Promote and assure the application of appropriate standards of data analysis within the IDN and ensure that all analytics are quality-checked
• Partner with the Director of Finance and Analysis in analyzing managed care contract proposals and counter-proposals related to physician recruitment
• Update and maintain all fee schedules for contracts and respond to requests from members for their specific fee information

Skills & Abilities

• Excellent written, verbal, and interpersonal communication skills
• Sound judgment and problem-solving skills
• Highly skilled in Microsoft Office Suite (including Excel, Access, and Word)

Qualifications

• HS Diploma (bachelor’s degree in business management, healthcare, hospital administration, or closely related field preferred)
• 4+ years of experience with substantial responsibility for complex data analysis in a managed care environment
• Demonstrated extensive knowledge of healthcare reimbursement, including hospital and provider billing and coding, reimbursement methodologies and plan payment policies
• Understanding of healthcare delivery systems, solid knowledge of all managed care products (HMO, POS, PPO, fully and self-insured products), physician referral arrangements, managed care processes, financial risk models, severity adjustment models, utilization management procedures, cost and quality tiering models, and pay for performance models