Job Description

Job Title: Payor Contract Analyst, Senior
Job ID: 684600
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Payor Contract Services
Location: 2 Hot Metal Street, Pittsburgh PA 15203

Description


The Payor Contract Services group at UPMC is seeking a candidate with a strong background in healthcare reimbursement for their Senior Payor Contract Analyst position. The role, under minimal supervision is responsible for evaluating and negotiating complex health insurance provider contracts and relationships. Position will assist and educate intermediate and associate level staff.

Responsibilities:
  • Attend meetings with payors and other UPMC entities and /or departments to resolve contract issues when requested.
  • Data mine provider and payor financial and operational data for analysis. Define the necessary data elements required for the project.
  • Negotiates select payor contracts with management direction.
  • Perform testing on complex payor claims to ensure accuracy and compliance to contract terms.
  • Plan, develop and prepare complex reimbursement models, including but not limited to, tiered drg rates, case and per diem rates, day outliers, complex cost outliers, high cost medical surgical supply cost carve-outs, high cost drug carve-outs and complex fee-for-service fee schedules for the purpose of determining payor contract proposed terms as compared to current contractual terms and other comparable payor contract terms.
  • Prepares financial payor models and benchmark comparisons to support contractual decisions including assumptions, observations, conclusions and recommendations.
  • Proactively identify revenue generating opportunities or risks, researches and reports on payor market trends at the local and national level.
  • Researches and responds to complex internal and payor questions as they relate to contracts.
  • Routinely develop, review and analyze statistical, cost, and financial reports for complex payor contracts.
  • Supports contract negotiations through review of contract language, modeling of proposed contract terms and rates and makes recommendation as appropriate to department management.
  • Verification of payor rate schedule updates for compliance to contract terms. Educate and communicate payor methodology and/or rate changes to the appropriate internal UPMC entities and/or department staff.

Qualifications

  • Bachelors Degree in Finance, Business or related business field is required.
  • Minimum of five years experience in healthcare managed care and/or health care insurance provider contracting and/or medical or financial analysis or Revenue Cycle experience is required.
  • MBA or equivalent is preferred. 
  • Comprehensive understanding of healthcare terminology, insurance contract language and hospital/professional payment methodologies, including a good understanding of Medicare and PA Medicaid reimbursement. 
  • Proficient in Microsoft Excel, Crystal and Cognos.
  • Familiarity with Word and Access preferred. 
  • Must have strong analytical skills. Must have strong written and oral communication skills Must be an effective team player.

Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $26.64 to $44.88

Union Position: No

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