Payer Contract Variance Analyst

Department/Unit:

Patient Billing Service

Work Shift:

Day (United States of America)

Salary Range:

$60,367.47 - $90,551.20The Contract Variance Analyst is responsible for ensuring the integrity of the payments received for services rendered at AMHS are paid according to the signed contractual arrangement. This position is an advanced role as it not only verifies that the payments are paid according to contract terms, but it is the responsibility of this position to work internally to identify shortfalls within AMHS processes, systems, and contract terms with a goal of resolution and strengthening of the AMHS policies and procedures. This role will participate in the preparation for payer meetings and work with their internat leadership and external payer representatives to facilitate correct payments. The Analyst will work with the Contract Variance Specialist to identify any contract modifications needed internally to ensure that the expected payment calculated within Epic agrees to the signed contract terms. This position will work the hospital accounts receivable found in the variance WQs for all AMHS locations.

Develop/maintain payor scorecards to assist in contract negotiations

Planning and Program Development

Communicate with Senior Contract Variance Analysts to ensure contracts are loaded accurately.

Interpret and apply contract language to the claim payment calculation. These can be complex in nature and will utilize a higher level of analytical and critical thinking skills.

Ability to identify trends found in like claims or in contract logic is imperative in this role. The trend may be a result of payer practices or internal workflows.

Ability to work independently and under time constraints and deadlines and with minimal supervision. Able to prioritize workload in an effective manner.

Revenue Cycle Management

This position will work with staff and management across the revenue cycle which will enable this role to be visible and imperative to ensure the contracts and payments are accurate.

Responsible for ensuring the integrity of all expected payment calculations and actual payments made to Albany Med Health System (AMHS).

Analytical review of claims that have been processed without denials by the payor but have not paid according to contractual terms.

Develop and compile the findings each month to review with the Contract Variance Specialist and Manager. Maintain accurate records of all actions taken.

Monitors and maintains the Contract Variance worklists/reports to ensure timely action on claims to mitigate provider fault denials.

Demonstrates a thorough understanding of the AMHS revenue cycle, having interacted with Patient Access and Coding in varying capacities, this position requires a full understanding of the cycle from preservice to billing.

Participates in calls with Contracting Team and Payors as required.

Peer-to-peer support as needed to enhance the cross training within the department to expand the overall knowledge base of the Contract Variance team.

Associate's Degree - required

Thank you for your interest in Albany Medical Center!​

Albany Medical is an equal opportunity employer.

This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that:

Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Med Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.