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Payor Contract Analyst, Senior

  • Job ID: 351094330
  • 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: $28.33 to $47.73 / hour

Description

Payor Contract Services, the UPMC department that is responsible for the ongoing negotiation of the UPMC hospitals and physician contracts and associated payments is seeking a Payor Contract Analyst, Senior to become a member of their dedicated, harmonic, and successful team!

The Payor Contracts Analyst, Senior is a regular, full-time position that primarily works daylight hours, Monday through Friday.  A perk of this position includes flexible work arrangements!

The ideal candidate has strong Microsoft Excel skills and a passion for data analytics.  Prior experience with healthcare insurance contracts and Medicare payment methodologies is a plus.

Apply online today for your chance to join the team!  


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 is required.
  • 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 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.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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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