Job Description

Job Title: Payor Contract Analyst, Senior
Job ID: 770430
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 UPMC Payor Contract Corporate Services Department oversees and manages third party payer contract affairs including; but not limited to: payor rate development, language and rate review, understanding of quality incentive programs, contract compliance and preparation of models of reimbursement terms to support negotiations.


Apply your skills to a setting where you can make a significant, positive impact. The professional we are seeking will be highly motived, excellent communicator with good people skills.  Experience / knowledge of contract language and payment methodologies, superb analytical skills and attention to details are necessary to be successful in this position. Candidate should be comfortable working effectively in both an individual and team setting.  Prior experience with revenue cycle, patient accounting, third party contracting and/or contract modeling systems is a plus. Proficiency in Microsoft Excel and Word is required. The ability to learn database and reporting systems such as Cognos, Access and/or Crystal is desired.    


If you are someone who will embrace the growth and learning opportunities that UPMC’s as a world renowned academic medical center offers, please see below!


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 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: $27.43 to $46.22 / hour

Union Position: No

Apply Current Employee?

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.


WORKING HERE



Now more than ever, YOU can help us shape our communities and UPMC into a better place for everyone to work, study, play, and thrive.

Learn more about working here and check out our policies and recent updates.

UPMC Health Plan Named Best Places to Work for LGBTQ Equality in 2019


UPMC Ranked #1 Best Places for Women and Diverse Managers in 2019

Share:
Talent Network