Managed Care Financial Analyst
Northeast Georgia Health System, Inc.

Job Info

Improving the health of our community in all we do

Northeast Georgia Health System (NGHS)is a non-profit community health system on a mission of improving the health of our community in all we do. Our team cares for more than 1 million people across the region through four hospitals and a variety of outpatient locations. Northeast Georgia Medical Center (NGMC) has campuses in Gainesville, Braselton, Winder and Dahlonega - with a total of more than 700 beds and more than 1,100 medical staff members representing more than 50 specialties. NGHS also encompasses Northeast Georgia Physicians Group, a multi-specialty group with more than 65 locations, and The Heart Center of Northeast Georgia Medical Center, a cardiology practice with more than 15 locations.


Job Summary

Performs a wide range of complex managed care analytical and operational functions. Performs office procedures in support of managers. This position is responsible for managed care financial analysis, modeling and analyzing contract proposals, contract loading in both the Epic contract applications and the contract management system. This position is responsible for providing system-level support for Epic contract applications which include technical build, configuration, migration, maintenance and production support. This position works on complex problems where analysis of situations or data requires an in-depth evaluation and knowledge of the contract application. This person may also assist with contract negotiation processes as needed, make recommendations to the Managed Care negotiators regarding terms of the contract. This person will act as a liaison between contract management platform system administrators, IT Analysts and leadership, Revenue Cycle, and the Managed Care negotiators for resolution and feedback of any related items. This person may work with managed care payors to resolve claims and related issues in order to enhance managed care contract performance. Supports multiple managed care functions, including but not limited to Epic data integrity, contract management system integrity, managed care contract negotiations, and managed care payer relations, including both claim and operational issues, all in support of the Health System revenue cycle function. This position provides reports for the Medical Economics Manager and/or Contracts Integrity Managers concerning payment variance issues.

Minimum Job Qualifications

Bachelor's Degree and 2 years of related managed care contracting and/or billing/collection experience in a hospital and/or managed care payor setting; or in lieu of Bachelor's Degree 5+ years of relevant experience.

Epic Resolute HB/PB contract build experience preferred.

Epic reimbursement contract loading and/or government reimbursement experience preferred.

Epic Resolute Hospital Billing Expected Reimbursement Contracts Management Certification preferred
Epic Resolute Hospital Billing Expected Reimbursement Contracts Administration Certification preferred

Essential Tasks and Responsibilities

1. Able to understand and interpret Managed Care Contracts. Research, collect, and analyze contract information as required.

2. Ability to accurately build contracts into the contract management system and Epic contract applications.

3. Modeling contracts to determine appropriate financial terms.

4. Management of the process involved with identifying, analyzing, and resolving financial calculation issues between payer and provider.

5. Possess a specific knowledge of Third-Party Healthcare Arrangements and is able to apply that knowledge.

6. Must be able to calculate and audit expected reimbursement in order to determine accuracy of payment.

7. Must be willing to learn and act as a "System Administrator."

8. Must be able to make the appropriate payment classifications determination and record it accurately in the system.

9. Continually seeks ways and means for improving the delivery and support of Managed Care Modeling & Reimbursement System feedback.

Relocation allowance for out of state candidates

Medical, Dental, Vision, 401k, up to 24 days PDO for FTE


Since first opening its doors in Gainesville in 1951, Northeast Georgia Medical Center has added hospital campuses in Braselton, Barrow and Dahlonega - and become Georgia's most awarded hospital. Some recognitions include being named to these lists:

America's 50 Best Hospitals- Healthgrades

100 Top Hospitals- Truven Health Analytics

100 Hospitals with Great Heart Programs- Beckers Hospital Review

America's Top Quality Providers- Carechex

Atlanta's Top 150 Workplaces- Atlanta Journal-Constitution

Healthcare's Most Wired Hospitals and Health Systems- Hospitals & Health Networks magazine

NGMC has also been recognized in recent years as Georgia's #1 Hospital for overall hospital care, overall surgical care, heart care, orthopedic surgery, women's care and more.

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