Contract Operations Analyst

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The purpose of this position is to provide analysis as well as monitor, guide and enhance the processes related to the assessment, build and ongoing maintenance of providers, groups, and IPAs for new and existing contracts. This role requires intra-departmental communication, process management and collaboration with our Contracting, Credentialing, Provider Network Operations, and IT Staff to become a partner in the plan’s strategic network growth and contracting initiatives.

The Contract Operations Analyst will provide a variety of reports and assessments of a provider’s network, utilization, financials, and quality as it pertains to arrangements being sought between the entity and the plan. The reports delivered will be instrumental in determining how the plan engages with our network on an ongoing basis. There will also be a need to perform the assessment of systems data to ensure that our credentialing systems are aligned with the data in our primary claims system to ensure a smooth provider experience. The ongoing processes implemented to achieve these goals will also need to be documented, improved with experience and able to be transitioned to new systems as needed.

Job Description

Perform analysis on individual providers, groups, IPAs, and contracted vendors as it pertains to historical network performance related to risk, utilization, financials and quality performance. Assess external provider rosters for current network overlap, growth opportunities and pre-existing reimbursement rates. Review fee schedules set by CMS (RBRVS) and the NYSDOH (eMedNY) for accurate representation within our contractual arrangements. Report on performance of current contractual arrangements including the modeling of proposed changes. Identify and reconcile issues due to provider or vendor configuration errors within our claims system. Collaborate with other departments to follow the provider build process through its various steps to ensure initial and ongoing accurate representation in our primary claims system. Build out process documentation that is iterated upon and improved to expose the provider build process to stakeholders and implement checks and balances across various steps/departments with the goal of ensuring timely and accurate representation in our systems of the agreed upon arrangements. Stay informed of new and upcoming changes to our arrangements and adjust accordingly. Prepare analyses of contracted services from large, shared databases utilizing queries and externally provided data. Support staff on various initiatives as it pertains to value-based payment (VBP) arrangements, provider contracts, finance, risk, and quality. Work on special projects as needed and assist in various areas of contracting.

Minimum Qualifications

Bachelor’s degree or equivalent experience required. 2+ years of claims, health care provider payment methods, and billing configuration experience. Intermediate to advanced experience with MS SQL, Excel, or other programming/query languages. Experience working with large data systems. Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes. Experience with claims data at it pertains to the healthcare industry. Ability to build and foster relationships at all levels of the organization.

Professional Competencies

Integrity and Trust Customer Focus Open to collaborate to share ideas and findings. Excellent communication skills, written and verbal. Functional/Technical skills Written/Oral Communication