Senior Contract Analyst (Managed Care) (Hybrid position)

We have an exciting opportunity to join our team as a Senior Contract Analyst (Managed Care).

In this role, the successful candidate as the Senior Contract Analyst is responsible for organizing and reviewing financial and utilization data and hospital billing data.

This position is responsible for creating and analyzing profit and loss reports and other managed care reports from the cost accounting system.

The incumbent will create managed care reports with detailed financial utilization data from other data sources. Additional responsibilities include reviewing all managed care contracts and addressing changes that impact these contracts, validation of contract compliance and other provisions of managed care..

Job Responsibilities :

• Organizes and reviews financial and utilization data, including insurer claims, eligibility, hospital and physician billing data, payer’s fee schedules, Medicare RBRVS fee schedule and Medicaid APG and ordered ambulatory fee schedules.
• Reviews and has a keen understanding of all the managed care contracts; provides analytical support regarding modeling, models the payer’s rate proposal and provides recommendations to the leadership team to maximize reimbursement with the managed care payers and alleviate any contract terms that create payment rate discrepancies.
• Loads and reviews all contracts in EPSi contract modeler. Manages a tracker for EPSI projects and data loaded into EPSI via DSS.
• Identifies new and deleted / replaced CPT / revenue codes that affect the Managed Care contracts.
• Utilizes EPSi reporting capability of the hospital decision support system to create managed care reports and to generate and analyze profit and loss reports on individual contracts.
• Audits payor contracts in EPIC patient billing system to ensure the Managed Care contract terms are loaded consistent with the agreement.
• Prepares payor compliance reports identifying areas of underpayments, zero payments and overpayments for the hospital. Identifies detailed issues contributing to discrepancies and recommends action plan to correct issues and summarizes and presents data to senior management
• Provides assistance to other departments to support financial management and evaluation of hospital contracts.
• Supports the contract negotiation process and contract information dissemination by preparing current and projected financial performance models including identifying areas of contract improvement and preparing contract proposals and counterproposals.
• Provides orientation, guidance and assistance to Contract Analyst and less experienced staff for all related job responsibilities.
• Reviews and evaluates project requests, determines appropriate approach, and coordinate completion of project work and schedules.
• Creates ad hoc reports from data sources such as EPSi and business objects for Managed Care and other internal departments who require Managed Care’s support.

Minimum Qualifications :

To qualify you must have a Bachelors degree in Business Administration or relevant discipline and 5+ years relevant experience or an equivalent combination of education and experience.

Proficiency using relational databases, database concepts and software applications; must have MS Access and Excel knowledge.

Excellent interpersonal and presentation skills.Knowledge of healthcare terms and reimbursement analytical and problem solving skills .

Preferred Qualifications :

Preferred Qualifications : Familiarity with Crystal / EPSi reporting and EPIC..

Qualified candidates must be able to effectively communicate with all levels of the organization.

NYU Langone Health provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents.

NYU Langone Health is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment.