socialwork | Network Development Analyst - MediGold - Corporate Services Center - Columbus in Columbus, OH

Network Development Analyst - MediGold - Corporate Services Center - Columbus

  • Mount Carmel Health System
  • $83,840.00 - 148,150.00 / Year *
  • 1784 Elmore Ave
  • Columbus, OH 43224
  • Full-Time
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At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve. MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. Were dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

The Network Development Analyst supports Provider Relations/Integration by analyzing the numbers and types of Providers required to serve the healthcare needs of the MediGold membership in accordance with the Center for Medicare and Medicaid Services (CMS) guidelines. This position is integral to the team that maintains MediGold's superior Star ratings and member satisfaction and retention by analyzing and recommending an appropriate choice of accessible physicians, facilities, and ancillary providers. Provides financial reports and assessments of contract proposals and performance.

Responsibilities

  • Works with multiple business units in addition to Provider Contracting and Integration including Member Relations, Support Services, and Finance to develop reports supporting network adequacy.
  • Analyzes contract proposals and models what-if scenarios related to reimbursement terms, quality incentives, and changes in payment methodologies.
  • Provides cross-training and backs up other colleagues in Provider Relations during high volume, seasonal production periods and other staffing shortages.
  • Suggests efficiencies and improvements to regular report requirements.
  • Prepares monthly analyses and ad-hoc reports supporting contract performance outcomes.
  • Reports on contract performance and supports financial reconciliations to budgets and expected outcomes.
  • Develop expertise in software packages that analyze geographic network adequacy, report on population risk management, and basic operational systems for billing, provider credentialing, and call center services.
  • Responsible for the integrity of reports and thorough documentation for supporting documents and methodologies for report production.
  • All other duties as assigned.
  • Requirements

  • Education: Bachelor's degree in Accounting, Finance, or Business
  • Experience: At least 3 years in financial analysis required; healthcare experience preferred
  • Demonstrates strong analytical problem solving ability
  • Above average proficiency in Excel, Outlook, Word and PowerPoint
  • Outstanding organizational and time management skills
  • Ability to prioritize and handle multiple deadlines
  • Discovering opportunities, support and excellence all while making a real difference in patients lives begins at Mount Carmel. Find a new beginning and advance your career with us.

    Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.


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    * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.