Payor Contracting Analyst

Remote position 

Benefits:

• Competitive Health & Welfare Benefits


• HSA with qualifying HDHP plans with company match


• 401k plan after 6 months of service with company match (Part-time employees included)


• Employee Assistance Program that is available 24/7 to provide support


• Employee Appreciation Days


• Employee Wellness Events

Minimum Qualifications:

• Minimum of three years of experience working in an analytic role in a healthcare environment (payor or provider) with an in-depth knowledge of physician reimbursement methodologies.


• Intermediate to advanced-level MS Excel skills (pivot tables, vlookups, conditional formulas).


• Experience using relational databases.

• Bachelor’s Degree in Finance or Healthcare Administration preferred.

Essential Functions

• Demonstrate thorough knowledge of CMS regulations and reimbursement methodologies relevant to professional claims.


• Familiarity with value-based care payment models and industry trends.


• Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs.


• Familiar with a variety of concepts, practices, and procedures in the field of managed care and practice management.


• Possesses strong organizational skills and careful attention to detail.


• Must be able to problem-solve and come forward with recommendations.


• Must be able to stay on task with minimal supervision.


• Excellent critical thinking, troubleshooting, and analytical skills.

KNOWLEDGE

• Knowledge of physician reimbursement.


• Knowledge of provider billing practices.


• Knowledge of CPT codes, modifier rules, CMS payment policies.

SKILLS

• Skill in effective data collection and analysis.


• Skill in designing analyses and appropriate reports.


• High-level attention to detail, accuracy, and organization skills.

ABILITIES

• Strong ability to prepared and understand functional and technical specifications.


• Ability to analyze problems and interpret information and prioritize and reprioritize, as necessary.


• Ability to work independently, and as part of a team.


• Ability to multi-task, manages multiple projects, and meets tight deadlines.