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Overview Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence-based practice to improve outcomes – to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! Position Summary: Manage underpaid insurance balances that are unable to be resolved through routine follow up activities. Analyze payment discrepancies for trends, contract interpretation and rate load issues. Position requires a thorough understanding and knowledge of managed care contracts, practice and policy. Job Details Duties and Responsibilities Primary: Contributes to and consistently applies CHS Services’ policies, procedures, and benefits to all customers and/or employees without discrimination. Employee conducts himself/herself in conformity with the HIPAA Compliance Program and applicable institutional policies and procedures for patient privacy. In addition, employee conducts himself/herself in conformity with the CHS Security policies and procedures. Analyze claims data with the goal of identifying and quantifying payment issues and trends in payer activity. Coordinates all facility credentialing with the managed care plans. Coordinates the validation of contracts as loaded in contract management systems. Works with Managed Care team on recovery efforts tied to identify variances. Conducts follow up activities with payers as assigned. Conducts rate analysis for rate recycling. Prepares and maintains revolving spreadsheets. Prepares settlement files. Assists in the development and maintenance of payer dashboards. Assists Vice President in the development of training tools. Supervises the day-to-day work of the Escalation Unit Analysts. Evaluates the performance and completes performance review/evaluations of the Escalation Unit Analysts. Responsible for training the new analysts for Escalation Unit. Position Requirements and Qualifications Education: Bachelor’s degree preferred, comparable work experience considered in lieu of bachelor’s degree. Skills: · Proficient in designing, building reports and analyses in various Microsoft based data analysis tools. Proven experience working with large and complex SQL databases preferred. Strong ability to analyze and accurately summarize complex claims data and effectively communicate conclusions. Excellent communication skills. Experience: 3-5 years previous experience working with data analysis – preference for experience in a managed care setting. Prior experience training individuals and small groups. Prior experience creating and presenting materials for information and training purposes. Experience with hospital billing and or decision support systems a plus. Strong knowledge of the managed care environment including provider, payer, and employer. Salary Range USD $100,000.00 - USD $120,000.00 /Yr. This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits. At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.