Payor Contract Analyst, Intermediate

We're searching for a Payor Contract Analyst, Intermediate to join the team! If you're a self-motivated individual with knowledge of payor contracting, this could be the perfect fit for you!

The Payor Contract Analyst, Intermediate supports the development, negotiation, implementation and maintenance of managed care and payor agreements as well as relationships with various payors and internal stakeholders. They'll analyze contract terms, reimbursement and the financial impact of negotiations.

This full-time position offers a hybrid work environment. Apply online today for your chance to join the team!

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.

• Data mine provider and payor financial and operational data population for analysis. Define the necessary data elements required for the project.

• 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.

• 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.

• Verification of payor rate schedule updates for compliance to contract terms.

• Interact as a team member of the department to achieve maximum outcomes.

• Prepares financial and operational activity reports to support contractual decisions including assumptions and observations.

• Bachelor’s degree and one year of related work experience

  • OR Associate’s degree and three years of related work experience
  • OR High School Diploma and five years of related work experience required.

• Solid understanding of healthcare terminology, insurance contract language and hospital or professional payment methodologies including a general understanding of Medicare and PA Medicaid reimbursement.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran