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DescriptionDo you have exceptional analytical skills and healthcare experience? Are you eager to enhance your knowledge base and career? With training, would you have the interest and ability to build insurer contract payment models using specific payment methodologies such as DRGs with outliers or multiple surgery discount tiering in a decision support software system? Could you then generate and analyze the associated report results? Payor Contract Services, the UPMC department that is responsible for the ongoing negotiation of the UPMC hospitals and physician contracts and associated payments is seeking a Payor Contract Analyst, Senior to become a member of their dedicated, harmonic, and successful team. Excel proficiency and the ability to be an effective team member is essential. Prior experience with healthcare insurance contracts and associated payment rate analytics is a plus.Responsibilities:This position is primarily responsible for modeling provider contract payment rates with insurers in a contract modeling software system; performing payment comparatives between insurers and identifying negotiation and revenue opportunities.The position would lead or participate in projects from inception to conclusion, including project planning, reporting and analytics using the decision support software system or other databases. Project narratives, including criteria, observations, and conclusions, would be completed and presented to management and/or insurers based on specific project needs.
Proactively identify revenue generating opportunities or risks, researches and reports on payor market trends at the local and national level.
Routinely develop, review and analyze statistical, cost, and financial reports for complex payor contracts.
Attend meetings with payors and other UPMC entities and /or departments as needed.
Supports contract negotiations through review of contract language, modeling of proposed contract terms and rates and makes recommendation as appropriate to department management.
Verification of payor rate schedule updates for compliance to contract terms. Educate and communicate payor methodology and/or rate changes to the appropriate internal UPMC entities and/or department staff.
Prepares financial payor models and benchmark comparisons to support contractual decisions including assumptions, observations, conclusions and recommendations.
Perform testing on complex payor claims to ensure accuracy and compliance to contract terms.
Plan, develop and prepare complex reimbursement models, including but not limited to, tiered DRG rates, case and per diem rates, day outliers, complex cost outliers, high cost medical surgical supply cost carve-outs, high cost drug carve-outs and complex 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 for analysis.
Qualifications
Bachelors Degree in Finance, Business or related business field.
Minimum of three (3) years experience in healthcare managed care and/or health care insurance provider contracting and/or medical or financial analysis or Revenue Cycle experience.
MBA or equivalent preferred.
Comprehensive understanding of healthcare terminology, insurance contract language and hospital/professional payment methodologies, including a good understanding of Medicare and PA Medicaid reimbursement.
Proficient in Microsoft Excel.
Familiarity with Word and Access preferred.
Must have strong analytical skills.
Must have strong written and oral communication skills.
Must be an effective team player.
Licensure, Certifications, and Clearances:UPMC is an Equal Opportunity Employer/Disability/Veteran
REQNUMBER: 02432572
