Guidehouse Senior Database Support and Modeling Analyst - Managed Care in Jefferson City, Missouri
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It is the responsibility of the Database Support and Modeling Analyst to oversee the rate modeling within the Contract Management Database which will be used for rate analysis projects. Analyst will assist with preparing account dataset that will be included in rate analysis, activate pricing of rate model and validate expected pricing results. As the rate modeling specialist of the Contract Management Database, the Analyst will be responsible for auditing contract models for all projects to ensure the integrity of pricing performance. Analyst will preserve a skillset of the logic constructed within the Contract Management Database and will assist with developing logic that improves the functionality. Analyst will contribute to the overall health of the Contract Management tool by creating and maintaining various functions within database. This position will perform any and all job-related duties as assigned.
Essential Job Functions
Function self-reliantly to model rates within Contract Management Database
Perform User Acceptance Testing (UAT) of system development and enhancements
Participate in the development and implementation of new rate methodology logic
Audit the integrity of contract models and ensure pricing performance is as expected
Create and preserve contract rate methodology loading guides
Assist with maintaining all coding tables within Contract Management Database
Contribute to creating and maintaining useful provision/contract templates
Support the implementation of new client projects and rate and pricing analysis projects
Primary liaison between Contract Modeling and Contract Loading Team
Assist in support with Clients as directed by Senior Administrator of Contract Database Support and Modeling
Duties and Responsibilities
Skillful in translating contractual terms and model relevant parameters in Contract Management Database
Model rates and activate pricing on account dataset included within rate model analysis
Extract key account details along with modeled pricing results to format for rate analysis
Organize rate model documents in standard format on shared network drive(s)
Perform testing within UAT and production environment ensuring stabilization of system functionality after upgrades and enhancements are deployed
Research and secure thorough understanding of new rate methodologies and participate in system development and implementation
Complete audits of new and existing contract models and provide feedback in set formats
Identify and report problematic rate modeling functionality and recommend improvement
Regular communication with Data Service Team to validate account datasets importing into Contract Management Database
Oversee the creation and maintenance of contract loading guides for all rate methodologies utilized within Contract Management Database
Assist with updating and maintaining all coding tables within Contract Management Database that is utilized for various functionality
Contribute to creation and maintenance of useful service category provision templates
Help with reviewing and resolving modeling inquiries from contract modeling team(s)
Maintain confidentiality of all private health information and contractual terms
Complete assigned responsibilities in a timely, accurate and thorough manner
Report conflicting terms within payer contracts subject to adverse effect on revenue
Provide support as needed by hosting or attending project meetings
Perform all responsibilities and communication in a professional manner
Education /Qualifications /Experience:
Minimum of 5 years’ experience in a Managed Care database environment
High school diploma required. Associates degree and/or technical training preferred
Comprehensive knowledge of medical reimbursement methodologies including per diem, case rates, DRG rates, ASC rates, APC rates, fee schedules, EAPG rates, APR DRG rates, stop loss provisions and Carve-outs
Accustomed to an organized project structure that affords successful proactive outcomes
Knowledge of Microsoft Word, Access, EDI systems and strength within Excel
Familiarity with concepts of database management and obtaining data sets for analysis
General knowledge of hospital-based patient accounting and contract management systems preferred
Wide-ranging knowledge of medical coding methodologies including Rev Code, ICD-10, CPT, HCPCS, MS DRG, APR DRG, ASC, EAPG and APC
Understanding of medical billing procedures and forms including UB-04 and HCFA-1500
Working knowledge of medical terminology
Sound familiarity with managed care payer contracts and product offerings
Possess effective/accurate oral and written English communication skills
Capable to identify contractual terms subject to multiple interpretations
- The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Rewards and Benefits
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.