Contract Management Analyst
The Contract Management Analyst is responsible for maintaining all payor contracts. Performs analysis, modeling, and data generation within the contract management software.
- Responsible for reviewing and analyzing all documentation associated with payer reimbursement contracts.
- Determine how information should be modeled within the RCM Contract Management software.
- Performs analysis, modeling and data generation within the contract management software using payer provided contractual information.
- Reviews payer contracts and associated documentation to ensure accurate contract modeling.
- Proactively identifies errors with contract management software calculation of the contractual variances.
- Communicates any issues associated with the modeling of the contract to the appropriate team member or payer contacts.
- Maintains a proficiency of payment terms and conditions of Commercial and Government contracts to ensure that all are accurately represented in all applicable system applications and reference documents.
- Serves as a lead with assigned Payors to address contract and Payor related issues on behalf of internal departments.
- Works with various system applications, and in collaboration with other departments, to identify underpaid accounts. When denial trends are identified where payments are deficient, works with payor to resolve issues and collect additional monies due.
- Timely resolves underpayments or denial trends, while addressing any root causes that are contributing to incorrect payments.
- Investigates revenue processes to ensure system is optimizing reimbursement while maintaining compliance with applicable rules and policies. Assists with recommended action steps and works collaboratively with other departments to improve processes when control, operational weaknesses and/or compliance issues are found. Performs follow up reviews to ensure action steps were met. Develops ways to trend issues.
- Investigates billing system errors and develops corrective action(s) that will ensure appropriate reimbursement. Follows through with the department to ensure compliance with changes.
- Communicates & distributes new payor contract terms and conditions, changes, and payor notifications to internal stakeholders.
- Prepares and provides necessary paperwork and education with internal stakeholders on new payment terms and changes to ensure operational processes are understood and implemented.
- Assists with the development of the quarterly yield report as needed, which includes investigation of potential errors to ensure accurate yield performance by Payor.
- Prepares variance analysis and supports senior analyst with analysis of information as needed. This also includes the development of payor concentration reports and other requests for various reports.
- Payor data and policy collection, and assistance with financial analysis, as necessary for third party contract negotiations.
- Maintains working knowledge of Patient Accounting systems utilized by the System, as applicable, to research root causes of underpayments and denials.
- Manages special projects as assigned by the Manager of Patient Accounts and/or Chief Financial Officer.
- Works closely with team members to ensure they have all necessary contract information and performs quality assurance testing to confirm all terms are modeled correctly.
- Performs other duties as assigned.
- 2 years in Healthcare Business Operations, Audit or Finance providing basic knowledge of payers, reimbursement, and familiarity with DRG, HSCPS, ICD10, CPT, etc.
- Previous experience in contracting with a high degree of comprehension in contract language.
- Must have Excellent written & oral communication skills
- Detail oriented with ability to work issues to resolution.
- Must be able to work independently as a team member in a fast-paced environment while managing multiple priorities.
- Intermediate Microsoft Office skills, with proficiency with Excel.
- Ability to collect and analyze data, define, and troubleshoot problems.
- Basic understanding of healthcare billing.
- Basic computer skills.Works effectively in a team environment.
- Bachelor's Degree in Business/Accounting, Finance, Healthcare Administration, or related field
- Previous experience in Contract Analyst/Management role in Healthcare
- Certification in Contract Management (CPCM)
- Frequent standing, stooping, bending, stretching, squatting; must be able to stand/walk for most of the workday; heavy lifting, must be able to lift packages up to 75 pounds
- Must be able to work paying close attention to detail with frequent interruptions
- Ability to work in a fast pace environment