Provider Payment Analyst II
Partnership HealthPlan of CaliforniaFairfield, California, United States
Posted November 7, 2023
103059.95 - 133977.94 USD year
Full Time
About the Company
Partnership HealthPlan of California is a non-profit community-based health care organization that administers Medi-Cal benefits through local providers, ensuring high-quality, cost-effective health care for recipients. With a mission to help members and communities be healthy, the organization aims to be the most respected managed care plan in California.
Job Description
The Provider Payment Analyst II supports the development, evaluation, and advancement of provider reimbursement methodologies to align with organizational strategies and objectives. The role involves complex research and analysis of various internal and external data sources to inform provider reimbursement decisions and strategies.
Requirements
- Bachelor's degree or above in Business Administration, Computer Science, Healthcare Administration, or related field
- Minimum 4 years of experience working with a managed care organization or health insurer, in a provider contracting or analysis role
- Experience with physician/facility/ancillary reimbursement methodologies is preferred
- Knowledge of State and Federal regulatory bodies, DHCS, CMS, DMHC, and NCQA, and Medi-Cal and Medicare benefits
- Medi-Cal experience with a variety of contracting models using capitation, fee-for-service, per diem, case rates, risk arrangements and pay for performance
- Knowledge of managed care concepts, contracting, reimbursement, data, policies, and procedures
- Proficient in Microsoft Excel, Business Intelligence software, and database applications
- Valid California driver's license and proof of current automobile insurance compliant with Partnership policy
Benefits
- Health insurance
- Retirement plan
- Paid time off
- Holidays
- Life insurance
- Disability insurance
