Description

The Operations Analyst reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities:

Works with multiple operations departments including Revenue Cycle, Information Systems and Access, to implement the operations of the managed care, government and special project contracts, as well as any major administrative payer requirements that have a material financial impact.
Participates in regular meetings with the vendor in maintaining and updating the insurance on demand tool. Continuously provides feedback and recommendations for a better end user experience that provides an efficiency and ease of navigating the tool.
Collaborates with Sr. Operations Analyst to understand and load contract logic within the Epic patient accounting system to calculate expected reimbursement accurately on billed charges, which will directly affect Accounting/Finance tasks.
Ensures assigned payer contracts are loaded correctly into the NM system and in a timely matter and approves the testing of the reimbursement functions.
Responsible for supporting various departments through the escalation of tickets through the Service Now portal based on the appropriately assigned payor and/or category.
Works with Sr. Operations Analyst to create reimbursement tools with all managed care contracted rate schedules by region for the patient accounting teams to utilize when following up on managed care accounts.
Researches and works out resolution on contract load issues resulting in discrepancy of payment.
Performs special projects as duties as assigned by the Manager and Director, Managed Care.

Qualifications

Required:

Bachelor’s degree in Business Administration, Healthcare Management, Communications or related field preferred or equivalent experience
Minimum 2 years of relevant experience in a managed care organization, consulting firm, hospital system/hospital
Excellent written and oral communications skills are necessary
Strong organizations skills and experience with managed care contracting is essential
Knowledgeable in A/R, Claims Management or Patient Accounting functions
Proficiency in data analysis

Preferred:

Five or more years of relevant experience in a managed care organization, consulting firm, hospital system/hospital.
Physician Billing

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

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Operations Analyst Managed Care (Hybrid)