DUTIES: The Department of Managed Care at SUNY Downstate Health Sciences University is seeking a full-time Senior Financial Analyst. Responsibilities and duties will include: - Serve as the overall Project Manager for SUNY Downstate's participation and performance in Healthfirst's QIP program. Assist the Director of Managed Care with managed care negotiations- including contract review, financial analysis, and preparing proposals. - Provide support to the Department's managed care contracting activities through participation in negotiation conference calls and meetings with payers and serving as a key liaison between payers UHB, and UPB staff related to contract terms, rates, payments and denial and quality payments. - Working with our contracted plans and internal departments, track and monitor the UHB's PCMH revenue. - Manage the financial analysis and approval process for Baha and Cochlear implants. Monitor that UHB receives the rebates for these procedures. - Work with plans to address denials and underpayments. Prepare rate transmittals. Work with plans and IT to ensure payment methodologies and rates are loaded correctly. Maintain accurate database of UHB and UPB contracts, delegation agreements, and provider's correspondences related to Managed Care contracting. Work with plans to obtain current agreements to complete contract database. Provide routine and ad hoc analysis and reporting needed for the various functions of managed care. - Work in collaboration with the department's Managed Care Coordinators on other non-HF quality incentive programs. Other responsibilities as needed. (DUTIES AND RESPONSIBILITIES ARE NOT LIMITED TO THE ABOVE POSITION DESCRIPTION) QUALIFICATIONS: B.A. Required, MPH preferred. 4 years of experience working in healthcare or health insurance/ benefits. Working knowledge of health claims or revenue cycle ideal. Additional Info: * Represents Location Pay for full-time appointees. Hours of work: 8- 9AM - 4- 5PM. Days of week: Monday - Friday. Hours per week: 35.Closing Date: Open Until Filled STATE UNIVERSITY OF NEW YORK IS AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER
Internal Number: 52693
About SUNY Downstate Medical Center
SUNY Downstate's College of Medicine, Health Related Professions, Nursing and its School of Graduate Studies offer students a broad professional education that will prepare them for practice or careers in any location and community. This education provides exceptional opportunities for those students with a commitment to promoting health in urban communities and addressing the complex challenges of investigating and preventing diseases that confront clinicians, educators, and researchers in such an environment. This special aspect of Downstate's unique mission is reflected in the students it attracts and selects, the vast majority of whom are drawn from the New York City Metropolitan area. Many of these students are members of minority and cultural groups underrepresented in the health professions, and/or come from families of first-generation immigrants or from economically disadvantaged backgrounds.