Job Description

Job Title: Payor Contract Analyst, Senior
Job ID: 03609923
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility:
Department: Payor Contract Services
Location: 2 Hot Metal Street, Pittsburgh PA 15203

Description

Do you have exceptional analytical skills and healthcare experience? Are you eager to enhance your knowledge base and career? Payor Contract Services, the UPMC department that is responsible for the ongoing negotiation and performance of the UPMC hospitals, physicians and ancillary providers contracts is seeking a Payor Contract Analyst, Senior to become a member of their dedicated team. Excel proficiency and the ability to be an effective team member is essential. Prior experience with healthcare insurance contracts and the payment methodologies associated with various services is preferred.

Responsibilities:

The position would participate in projects from inception to conclusion, including project planning, reporting and analytics using data generated by the decision support software system or other data bases. Project narratives, including criteria, observations and conclusions would be completed and presented to management and/or insurers based on specific project needs.

The position would:
  • Proactively identify revenue generating opportunities or risks, researches and reports on payor market trends at the local and national level.
  • Routinely develop, review and analyze statistical, cost, and financial reports for complex payor contracts.
  • Attend meetings with payors and other UPMC entities and /or departments as needed.
  • Support contract negotiations through review of contract language, modeling of proposed contract terms and rates and make recommendations as appropriate to department management.
  • Verify 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.
  • Prepare financial payor models and benchmark comparisons to support contractual decisions including assumptions, observations, conclusions and recommendations.
  • 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.
  • Data mine provider and payor financial and operational data for analysis. Define the necessary data elements required for the project.

Qualifications

  • Bachelors Degree in Finance, Business or related business field. 
  • Minimum of three (3) years experience in healthcare managed care and/or health care insurance provider contracting and/or medical or financial analysis or Revenue Cycle experience. 
  • 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.
  • 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/Disability/Veteran

Salary Range: $27.43 to $46.22 / hour

Union Position: No

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