Payor Contracting Analyst - Managed Practices

Job Description

Job Description

ESSENTIAL FUNCTIONS

• Prepare analysis related to the financial performance of payor physician and facility contracts and contract proposals. Work in collaboration with contracting staff to develop contract proposals to improve contract financial performance.
• Extracts and queries data from multiple sources and systems and compile data in the form of written and verbal reports and presentation.
• Create queries to pull financial/claims data that will then be used to develop analytical and statistical models to help customers make informed business decisions
• Obtains updated payor fee schedules information from payors.
• Transfers fee schedule information to Revenue Cycle.
• Supports Revenue Cycle in contract and fee schedule interpretation and payment validation.
• Provide analysis for all payor agreements to identify improvement opportunities and prioritize contract renegotiations.
• Evaluate current contracts to market benchmarks utilizing a variety of payor transparency data sources. Assist in the development of projected revenue improvements
• Develop management reports to monitor contract performance.
• Supports Management by providing information, locating data sources, and collecting data under tight time constraints.
• Create financial models as required to analyze data and report efficiently for existing and new reports.
• Identify and analyze utilization patterns driving health care costs and recommend actions to impact financial performance
• When necessary, serves as the liaison between health plans, revenue cycle, and credentialing departments.

EDUCATION

• Bachelor’s Degree in Finance or Healthcare Administration preferred.

EXPERIENCE

• Minimum of three years of experience working in an analytic role in a healthcare environment (payor or provider) with an in-depth knowledge of physician reimbursement methodologies.
• Intermediate to advanced-level MS Excel skills (pivot tables, vlookups, conditional formulas).
• Experience using relational databases.

REQUIREMENTS

• Demonstrate thorough knowledge of CMS regulations and reimbursement methodologies relevant to professional claims.
• Familiarity with value-based care payment models and industry trends.
• Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs.
• Familiar with a variety of concepts, practices, and procedures in the field of managed care and practice management.
• Possesses strong organizational skills and careful attention to detail.
• Must be able to problem-solve and come forward with recommendations.
• Must be able to stay on task with minimal supervision.
• Excellent critical thinking, troubleshooting, and analytical skills.

KNOWLEDGE

• Knowledge of physician reimbursement.
• Knowledge of provider billing practices.
• Knowledge of CPT codes, modifier rules, CMS payment policies.

SKILLS

• Skill in effective data collection and analysis.
• Skill in designing analyses and appropriate reports.
• High-level attention to detail, accuracy, and organization skills.

ABILITIES

• Strong ability to prepared and understand functional and technical specifications.
• Ability to analyze problems and interpret information and prioritize and reprioritize, as necessary.
• Ability to work independently, and as part of a team.
• Ability to multi-task, manages multiple projects, and meets tight deadlines.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment or remote work location
• Some travel within the community.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal business environment.
• Some bending and stretching are required.
• Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision, and Values must be acknowledged and adhered to

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.