Managed Care Analyst

Job description

Primary Accountability The Managed Care Analyst is responsible for using health plan data to validate, contrast, and track opportunities for revenue growth and compiling external and internal data reports to ensure compliance and efficiency. Description of Primary Responsibilities: - Responsible for producing, validating, and interpreting data for health plan membership and capitation reports and developing internal status reports to meet organizational revenue goals. - Defines data requirements and develops data collection and analysis tools for payer-specific identities. - Performs data validation to ensure integrity of reporting. - Identifies, investigates, and reports discrepancies in the data or workflows. - Maintains a work plan for post-production reports and presentations. - Produces monthly reports on payer revenue. - Maintains Compliance Data Base for all Health Plans and special projects. - Uses collected data to evaluate the profitability of payer relationships for all lines of business: - Medicare and Medicare Advantage Five Star Performance. - Medi-Cal Managed Care Health Plan Audit/Compliance and Incentives. - Commercial Health Plans P4P and HEDIS Performance. - Heal...