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Payer Contract Analyst

3 months ago

Jackson, United States West Tennessee Healthcare Full time

Category:
Professional

City:
Jackson
State:
Tennessee
Shift:
8 - Day (United States of America)

Job Description Summary:
Responsible for coordination of negotiations and implementation of contractual agreements between West Tennessee Healthcare and Managed Care Organizations (MCO's). Responsible for preliminary contract language review and negotiation with payor representatives, as well as financial analyses, where necessary. Makes recommendations as to acceptability of negotiated contract language and rate structures, where appropriate. Maintains both manual and automated systems used in contract discussion tracking, inclusive but not limited to contract pricing model application and customer-accessible databases containing contract terms and project status summaries. Provides support as initial point of contact for both internal and external customers in areas of contract implementation and education, as well as use of contract management systems (i.e., EPIC, rate databases, language databases). Primarily responsible for interpreting and loading managed care purchaser agreement terms into automated contract management systems, tests and implements new contract loads for use by internal customers in variance reporting and underpayment management. Maintains contracts as necessary when rates and/or reimbursement terms are updated.

ESSENTIAL JOB FUNCTIONS:

  • Responsible for coordination of negotiations and implementation of contractual agreements between West Tennessee Healthcare and Managed Care Organizations,
  • A. Responsible for preliminary contract language review and negotiation, while adhering to approved contract provisions and priorities;
  • B. Responsible for assistance with financial analyses, where necessary, in support of coworkers and internal customers' roles;
  • C. Makes recommendations as to acceptability of negotiated contract language and rate structures, based upon own judgment and experience, as well as research into market trends, based both internally and externally;
  • D. Maintains both manual and automated systems used in contract discussion, inclusive but not limited to contract pricing model and customer-accessible databases containing contract terms and project status summaries;
  • E. Provides support as initial point of contact for both internal and external customers in areas of contract implementation and education.
  • Serves as coordinator in use of contract management systems (i.e., EPIC, rate databases, language databases).
  • A. Primarily responsible for interpreting and loading agreement terms into automated contract management systems (i.e., EPIC);
  • B. Primarily responsible for testing and implementing new contract loads for use by internal customers in variance reporting and underpayment management;
  • C. Maintains reasonable availability in answering questions and troubleshooting these systems.
  • Develops an annual program of education and training for all facilities on latest contractual payment issues, as well as appeals processes as outlined within payor agreements;
  • Works directly with the Director of Managed Care to establish area goals and goal for this position.
  • Participates in periodic meetings with Director to discuss issues concerning managed care contract performance, identified trends, and issues dealing with our own procedures as they pertain to accurate account reimbursement and issues to be addressed in future contracting activities and goals.
  • Participates as a member of the Managed Care Department at West Tennessee Healthcare by, (1) participating in meetings, planning sessions, and brainstorming sessions, and (2) participating in promotional activities related to the managed care department.
  • Contribute to a positive work climate and the overall team effort of the department and hospital,
JOB SPECIFICATIONS:

EDUCATION:
  • B.S. in Accounting, Finance, or other Healthcare related field. Equivalent work experience taken into account in lieu of degree.
LICENSURE, REGISTRATION, CERTIFICATION:
  • Must become certified with EPIC Reimbursement Contracts within ninety (90) days of employment.
EXPERIENCE:
  • Minimum of three (3) years experience in a managed care operations environment, either working for a managed care organization, large integrated healthcare delivery system or like organization.
  • Strong working knowledge of hospital billing procedures and requirements.
  • Strong working knowledge or provider-side managed care agreement issues and priorities


NONDISCRIMINATION NOTICE STATEMENT

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, disability, religion, national origin, gender, gender identity, gender expression, marital status, sexual orientation, age, protected veteran status, or any other characteristic protected by law.