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Job Summary:

Responsible for the review, analysis and ongoing monitoring of managed care contracts for all Virtua entities to include both Virtua and payer compliance.  Supports value-based contract reconciliations and oversight of partial and full risk contracts.

Position Responsibilities:

Serves as liaison to Contract Management Administrator in the interpretation and implementation of contract packages to ensure proper pricing and collection of expected contract revenues.  Maintains mid-cycle checklist. Confirms annual contract rate increases and/or rate load with payers.  Prepares and processes Contract Management Reports as required. 

Supports process improvement efforts of internal and external customers by providing detailed root cause analysis.

Analyzes payer data related to value-based contracts to include leakage analysis and shared savings reconciliations in collaboration with VIN analytics.  Assists in validating utilization and quality data related to value based agreements.

Prepares financial models for contract renewal.  Measures mid-cycle contract financial performance and compliance.  Evaluates alternative payment methodologies.  Prepares impact analysis of regulatory and/or payer policy changes.  Facilitates payer claims audit of implant and drug carve outs.

Compiles the data needed for reporting related to the NJ Medicaid Access to Physician Services (MAPS) program.

Analyzes monthly Payment Variance reports to identify trends, payer payment discrepancies and/or internal calculation errors.  Supports Finance Departments in budget preparation. 

Prepare year end managed care statistics summary.

Participates in development of business plans for new programs and services. 

Supports Director and AVP in preparing ad-hoc reports and performing special projects.

Position Qualifications Required:

Required Experience:

Three(3) to five(5) years progressive experience in healthcare finance or managed care industry.  Background in payer community preferred. 

The Senior Financial Analyst must have excellent analytical skills, communication and presentation skills. 

Extensive experience with Microsoft Excel, Microsoft Access, Microsoft Power Point and Microsoft Word is also required. Working knowledge of EPIC Contract Management system. 

Applicant should be detail oriented, self- motivated and possess ability to work cooperatively with others in a team setting.  Must have ability to work independently and prioritize work assignments. 

Required Education:

Bachelor’s degree in Accounting, Finance, Business Administration, Healthcare Administration or related field required.

Training / Certification / Licensure:

EPIC hospital resolute billing certificate preferred.