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Guidehouse Senior Database Support and Modeling Analyst - Managed Care in Pierre, South Dakota

Overview

Guidehouse is a leading management consulting firm serving the public and commercial markets. We guide our clients forward towards new futures that build trust in society and your professional skills along the journey. Join us at Guidehouse.

Responsibilities

It is the responsibility of the Database Support and Modeling Analyst to oversee the rate modeling within the Contract Management Database which will be used for rate analysis projects. Analyst will assist with preparing account dataset that will be included in rate analysis, activate pricing of rate model and validate expected pricing results. As the rate modeling specialist of the Contract Management Database, the Analyst will be responsible for auditing contract models for all projects to ensure the integrity of pricing performance. Analyst will preserve a skillset of the logic constructed within the Contract Management Database and will assist with developing logic that improves the functionality. Analyst will contribute to the overall health of the Contract Management tool by creating and maintaining various functions within database. This position will perform any and all job-related duties as assigned.

Essential Job Functions

  • Function self-reliantly to model rates within Contract Management Database

  • Perform User Acceptance Testing (UAT) of system development and enhancements

  • Participate in the development and implementation of new rate methodology logic

  • Audit the integrity of contract models and ensure pricing performance is as expected

  • Create and preserve contract rate methodology loading guides

  • Assist with maintaining all coding tables within Contract Management Database

  • Contribute to creating and maintaining useful provision/contract templates

  • Support the implementation of new client projects and rate and pricing analysis projects

  • Primary liaison between Contract Modeling and Contract Loading Team

  • Assist in support with Clients as directed by Senior Administrator of Contract Database Support and Modeling

    Duties and Responsibilities

  • Skillful in translating contractual terms and model relevant parameters in Contract Management Database

  • Model rates and activate pricing on account dataset included within rate model analysis

  • Extract key account details along with modeled pricing results to format for rate analysis

  • Organize rate model documents in standard format on shared network drive(s)

  • Perform testing within UAT and production environment ensuring stabilization of system functionality after upgrades and enhancements are deployed

  • Research and secure thorough understanding of new rate methodologies and participate in system development and implementation

  • Complete audits of new and existing contract models and provide feedback in set formats

  • Identify and report problematic rate modeling functionality and recommend improvement

  • Regular communication with Data Service Team to validate account datasets importing into Contract Management Database

  • Oversee the creation and maintenance of contract loading guides for all rate methodologies utilized within Contract Management Database

  • Assist with updating and maintaining all coding tables within Contract Management Database that is utilized for various functionality

  • Contribute to creation and maintenance of useful service category provision templates

  • Help with reviewing and resolving modeling inquiries from contract modeling team(s)

Client Responsibility

  • Maintain confidentiality of all private health information and contractual terms

  • Complete assigned responsibilities in a timely, accurate and thorough manner

  • Report conflicting terms within payer contracts subject to adverse effect on revenue

  • Provide support as needed by hosting or attending project meetings

  • Perform all responsibilities and communication in a professional manner

Qualifications

Education /Qualifications /Experience:

  • Minimum of 5 years’ experience in a Managed Care database environment

  • High school diploma required. Associates degree and/or technical training preferred

  • Comprehensive knowledge of medical reimbursement methodologies including per diem, case rates, DRG rates, ASC rates, APC rates, fee schedules, EAPG rates, APR DRG rates, stop loss provisions and Carve-outs

Preferred:

  • Accustomed to an organized project structure that affords successful proactive outcomes

  • Knowledge of Microsoft Word, Access, EDI systems and strength within Excel

  • Familiarity with concepts of database management and obtaining data sets for analysis

  • General knowledge of hospital-based patient accounting and contract management systems preferred

  • Wide-ranging knowledge of medical coding methodologies including Rev Code, ICD-10, CPT, HCPCS, MS DRG, APR DRG, ASC, EAPG and APC

  • Understanding of medical billing procedures and forms including UB-04 and HCFA-1500

  • Working knowledge of medical terminology

  • Sound familiarity with managed care payer contracts and product offerings

  • Possess effective/accurate oral and written English communication skills

  • Capable to identify contractual terms subject to multiple interpretations

Additional Requirements

  • The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

Disclaimer

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

Rewards and Benefits

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

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