Payor Contracting Analyst - Managed Practices

Job Description

Job Description

ESSENTIAL FUNCTIONS

• Prepare analysis related to the financial performance of payor physician and facility contracts and contract proposals. Work in collaboration with contracting staff to develop contract proposals to improve contract financial performance.
• Extracts and queries data from multiple sources and systems and compile data in the form of written and verbal reports and presentation.
• Create queries to pull financial / claims data that will then be used to develop analytical and statistical models to help customers make informed business decisions
• Obtains updated payor fee schedules information from payors.
• Transfers fee schedule information to Revenue Cycle.
• Supports Revenue Cycle in contract and fee schedule interpretation and payment validation.
• Provide analysis for all payor agreements to identify improvement opportunities and prioritize contract renegotiations.
• Evaluate current contracts to market benchmarks utilizing a variety of payor transparency data sources. Assist in the development of projected revenue improvements
• Develop management reports to monitor contract performance.
• Supports Management by providing information, locating data sources, and collecting data under tight time constraints.
• Create financial models as required to analyze data and report efficiently for existing and new reports.
• Identify and analyze utilization patterns driving health care costs and recommend actions to impact financial performance
• When necessary, serves as the liaison between health plans, revenue cycle, and credentialing departments.

EDUCATION

EXPERIENCE

REQUIREMENTS

KNOWLEDGE

SKILLS

ABILITIES

ENVIRONMENTAL WORKING CONDITIONS

PHYSICAL / MENTAL DEMANDS

ORGANIZATIONAL REQUIREMENTS

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.