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   Current UPMC employees must apply in HR Direct

Payor Contract Analyst, Senior - Harrisburg

  • Job ID: 190492503
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Pinnacle
  • Department: Managed Care Contracting
  • Location: 1426 N Third Street, Harrisburg PA 17102
  • Union Position: No
  • Salary Range: $27.17 to $42.45 / hour

Description

Purpose:
Under minimal supervision, responsible for evaluating and negotiating complex health insurance provider contracts and relationships. Position will assist and educate intermediate and associate level staff.

This position will have the opportunity to work remote and at office as needed.

Responsibilities:

  • 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.
  • Negotiates select payor contracts with management direction.
  • Attend meetings with payors and other UPMC entities and /or departments to resolve contract issues when requested.
  • 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.
  • Prepares 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.
  • Researches and responds to complex internal and payor questions as they relate to contracts.
  • 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.
  • 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, 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:
Clearances must be dated within 90 days

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct