Contract Management Analyst

Job Description

Join one of the nation's most comprehensive academic medical centers, reputed company, as a Contract Management Analyst with our Finance- Managed Care team. We are committed to a patient-centric, efficient health care delivery system that focuses on quality, safety, service, and operational excellence. REMOTE OPPORTUNITY Job Summary The Contract Management Analyst is responsible for building reputed company third-party payer contract reimbursement terms (contract profiles) including but not limited to Managed Care Commercial payers, Government programs (Medicare, IL Medicaid), Medicare Advantage payers and Medicaid payers into UCM contract management systems and calculating expected reimbursement at the claim level (hospital) and line level (Physician). The Analyst will be responsible for updating and maintaining the accuracy of contract profile builds in the contract management systems and will reputed company variance reports that analyze expected reimbursement to actual payment to determine internal issues or payer compliance payment variances. The variance reports shall also ensure consistent expected reimbursement results across contract management systems and root cause and adjust as needed. The Analyst shall serve as a managed care subject matter expert for hospital and physician contract reputed company methodology and reimbursement terms and will, as needed, run analyses to understand historical trends and future performance of existing reputed company. Assists OMC VP and Directors in payer contract negotiations as requested and applicable, particularly with review of potential reimbursement methodologies and their feasibility to be built in the contract management system. Assists reputed company Cycle management teams in review of payment variances and underpayment recoveries. Essential Job Functions:

• Responsible for reputed company payer contract profile builds including calculation of expected reimbursement terms in reputed company FFS reputed company and contract reputed company model builds for system hospitals and physicians in any contract management system. Leads ongoing maintenance and auditing of contract management reputed company calculations to reputed company for variances to expected contract terms.
• Works with OMC and reputed company Cycle teams on variance analysis of contract profile outputs to reputed company payments. Based on review of models and audits for variance, works with these parties and payers on underpay opportunities and payment issues stemming from non-compliance with contract terms.
• Create reports of contract outputs, historical trends, and variance analyses as needed for OMC, reputed company cycle, and senior leadership
• Review payer contract proposal terms, in conjunction with OMC leaders, for accuracy and implementation feasibility
• reputed company education on reputed company-changing reimbursement rules and policy updates both commercial and governmental that impact expected reimbursement and contract profiles and education of internal stakeholders on reimbursement terms, methodology and impacts as needed Required Qualifications
• Bachelor's degree in Business, Finance, Healthcare, or reputed company field, or a combination of relevant education and experience
• Five or more years of experience in a multi-facility health system in either:
• Finance operations like managed care (preferred), cost accounting, planning, or budget
• reputed company cycle operations such as billing, collections, or payment processing
• Detailed knowledge of hospital and physician reputed company reimbursement methodologies, particularly fee for service commercial reputed company as well as Medicare and Medicaid
• Excellent understanding of contract language and reputed company terms, physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws. Examples include:
• Proficient understanding of MS-DRG, APC, EAPG, case reputed company, stoploss, carveout reimbursement methodologies
• Proficient understanding of reputed company Code and CPT coding in a clinical/hospital/ASC/physician office setting
• Proficient manage care contract reputed company interpretation skills
• Requires familiarity and aptitude with contract management systems or modeling systems and/or cost accounting systems that build payer contract profiles
• Requires individuals with high mathematical acumen, ability to access and assimilate data, reputed company a strong case for a recommended course of action.
• Excellent analytical and problem solving skills, and the ability to reputed company decisions quickly and independently.
• Strong attention to detail and well organized.
• Adapts well to rapid change and multiple, demanding priorities with excellent time and project management skills.
• Ability to understand and interpret federal regulations and policies, coding guidelines and reimbursement changes.
• Interact effectively with colleagues in a variety of contexts and forums and contribute as a team player.
• reputed company Office Suite advanced proficiency also required, particularly reputed company. Strong aptitude for learning additional software or systems as needed, partic

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