Job Description

Payroll Title:
MGD CARE SPEC 2
Department:
PHSO - MSO
Hiring Pay Scale
$36.00 - $50.00 / Hour
Worksite:
Greenwich Drive
Appointment Type:
Career
Appointment Percent:
100%
Union:
Uncovered
Total Openings:
1
Work Schedule:
Days, 8 hour shifts, Monday - Friday

#130875 Managed Care Contract Analyst - Hybrid

Filing Deadline: Fri 7/19/2024

UC San Diego values equity, diversity, and inclusion. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.

UCSD Layoff from Career Appointment: Apply by 07/09/24 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.

Special Selection Applicants: Apply by 07/19/24. Eligible Special Selection clients should contact their Disability Counselor for assistance.

This position will work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive and remote.

DESCRIPTION

Reporting to the Provider Network Contracts Manager, the Managed Care Contract Analyst compiles, validates, and analyzes healthcare cost, quality and utilization data to aid in contract negotiations as well as contract performance and network enhancement initiatives. In addition to gathering volume data and modeling of current reimbursement, the Managed Care Contract Analyst determines the need for reimbursement methodology changes and proposes target rates. Provides high level analysis to support the organization’s strategic goals and objectives.

Responsibilities include:

Provides support for special projects, which includes collecting, analyzing and modeling of claim data in preparation for payer contract negotiations. Prepares and analyzes physician practice reimbursement utilizing appropriate rates based on contract structure, place of service, provider and modifiers for each CPT code. Calculates Medicare reimbursement and compares to payer reimbursement for same volume.

Build financial and statistical models, analyze data, and translate analysis into specific, targeted action to drive results. Extract, compile, and format data to produce a variety of reports and presentations to management and executive leadership.

In collaboration with Network Contracts Manager, responsible for all aspects of Provider Negotiations including contract language review to negotiate language with providers to ensure favorable terms. Responsible for Contract Finalization and Implementation including the review of final documents to ensure accuracy upon agreement terms, return of countersigned documents to provider, communication of any pertinent changes throughout the system, and an audit of the contract build 3 months post implementation. Negotiates single case agreements for all entities as needed. Logs single case agreement and communicates such agreement to appropriate staff.

Independently analyzes, researches, and recommends resolution for contract disputes, non-routine claim issues, billing questions, and other practices. Communicates and assists with identification and implementation of issue resolution. Ensures issues are handled appropriately and professionally in accordance with payor and regulatory requirements. Data extraction for various reports and analyses upon request.

Works independently on multiple tasks, sets priorities, and develops comprehensive timetables and strategies to meet numerous and constantly changing deadlines. Leads Contract Implementation Workgroup. Collaborates with Network Contracts Manager to build and maintain cost effective, accessible provider network. Manages and maintains provider contracting database to ensure current, accurate ancillary, facility, and physician demographics and contract detail, and initiates database improvements.

MINIMUM QUALIFICATIONS

  • Six (6) years of related experience, education/training, OR a Bachelor’s degree in related area plus two (2) years of related experience/training. Related experience: Negotiating/executing Managed Care provider/ancillary/facility contracts. Experience in Provider Relations and some credentialing. Experience with claims adjudication.

  • Experience and proven success in managed care contracting, contract review, tracking, and maintenance.

PREFERRED QUALIFICATIONS

  • Experience in Managed Care, Provider Relations, provider office administration, or claims analysis.

  • Asana and programming experience.

  • Proficiency with MS Office (Excel, PowerPoint, Word) required. Knowledge of Excel, including VLookups and Pivot Tables.

  • Demonstrates analytical, problem solving, and critical thinking skills.

  • Strong organizational and written/oral communication skills.

  • Ability to work in a fast paced and changing environment. Excellent ability to manage to deadlines.

SPECIAL CONDITIONS

  • Must be able to work various hours and locations based on business needs.

  • Employment is subject to a criminal background check and pre-employment physical.

Pay Transparency Act

Annual Full Pay Range: $74,300 - $134,500 (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: $35.58 - $64.42

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).


If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

UC San Diego is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age or protected veteran status.

For the University of California’s Affirmative Action Policy please visit: https://policy.ucop.edu/doc/4010393/PPSM-20
For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Application Instructions

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