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   Current UPMC employees must apply in HR Direct

Payor Contract Analyst, Intermediate

  • Job ID: 156599741
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: Daylight Hours
  • Shift: Day Job
  • Facility: Corporate Payor Contract Srvs
  • Department: Payor Contract Services
  • Location: 2 Hot Metal Street, Pittsburgh PA 15203
  • Union Position: No
  • Salary Range: $21.91 to $37.83 / hour

Description

Do you have exceptional analytical skills and healthcare experience? If so, then this may be a great fit for you!

We are hiring a Payor Contracts Analyst - Intermediate to join our team. This is a regular, full-time position that primarily works daylight hours, Monday through Friday.  A perk of this position includes flexible work arrangements!

Our UPMC Payor Contracts Team is responsible for the ongoing negotiation of the UPMC hospitals and physician contracts.  The Payor Contracts Analyst - Intermediate is responsible for evaluating and providing recommendations regarding health insurance provider contracts and relationships.

The ideal candidate has prior experience with healthcare insurance contracts and associated payment rate analytics. Additionally, they have strong Microsoft Excel and analytical skills.

This is a great opportunity to join a team that interactions with various departments at UPMC.  Apply online today to be considered for the opportunity!


Responsibilities:

  • Prepare advanced reimbursement models, including but not limited to, case and per diem rates, cost and day outliers, and advanced 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.
  • Researches and responds to moderately complex internal UPMC entities and payor questions as they relate to contracts.
  • Coordinate the process of research on insurance companies and other payors medical policies, billing policies, contracted reimbursement rates and related issues to assist in evaluating and modeling payor financial performance in order to maintain or develop new or enhanced revenue streams.
  • Interact as a team member of the department to achieve maximum outcomes.
  • Verification of payor rate schedule updates for compliance to contract terms.
  • Prepares financial and operational activity reports to support contractual decisions including assumptions and observations.
  • Perform testing on advanced payor claims to ensure accuracy and compliance to contract terms.
  • Maintains Top Ten Payor Detail Matrix and Contracted Insurance Matrix for all hospitals.
  • Data mine provider and payor financial and operational data population for analysis. 

 

Qualifications

  • Bachelors Degree required.
  • Minimum one(1) year experience in healthcare managed care contracting and /or health care insurance provider contracting, and/or financial and medical analysis or revenue cycle experience.
  • Solid understanding of healthcare terminology, insurance contract language and hospital/professional payment methodologies including a general understanding of Medicare and PA Medicaid reimbursement.
  • Advanced working knowledge of Microsoft Excel, Cognos, Crystal and familiarity with Word and Access, preferred.
  • Must have solid analytical skills.

Licensure, Certifications, and Clearances:

  • Act 34

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