- Responsible for all contract administration, contract verification, and customer support for Proliance Care Centers
- Works directly with Provider representatives to resolve high level payment issues and disputes
- Monitors payment policies and procedures and distribute to Care Centers
This position reports to the Director of Analytics and Payor Contracting.
- Using Excel, Access, or other data analysis tools, develops analyses to support decision making.
- Acts as liaison between corporate and care centers for reimbursement and payer contracting issues
- Maintains a working knowledge of applicable Federal and State reimbursement laws and regulations as well as payor payment policies and procedures
- Identifies changes in regulations and payor policies on a timely basis, identifies the contracts impacted and related financial impact. Communicates changes to care centers
- Interprets contracts, models the fee schedule, loads the fee schedule into our EMR
- Compiles and maintains billing codes
- Monitors any monthly, quarterly, or yearly changes to CMS fee schedules, calculates the impact to each contract, updates the fee schedules accordingly
- Reviews claim payments to ensure contract implementations are correct, monitors’ compliance with contractual terms
- Attends and participates in internal and client meetings as needed
- Engages in process and quality improvement activities to minimize manual efforts
- Performs other duties as required by management
- Bachelor’s degree or greater in Finance, Accounting, Business Administration, Healthcare Management, or related field
- MBA/MHA preferred
- Minimum of 5 years’ experience working in the healthcare industry
- Payor contracting/ healthcare analytics background preferred
- Experience working in physician practices
Skills/Professional and Personal Qualities
- Knowledge of coding conventions i.e. (Revenue Codes, Occurrence Codes, ICD-9, ICD-10, CPT and HCPCS codes)
- Knowledge of the various types of health insurance payers: Medicare, Medicare Advantage Plans, Commercial, Medicaid, and Medicaid Managed Care
- Broad ranging knowledge of ASC’s, Clinics, and Ancillary Services
- Knowledge of healthcare reimbursement methodologies and contract language
- Strong analytical skills and familiarity with common data analytics tools including Excel, Access, or other analytics tools. Experience with Business Intelligence tools would be a plus
- Ability to communicate effectively using data with all levels of the organization
- Self-motivated team player able to multi-task and prioritize
- Ability to work independently and multi-task
How To Apply:
If interested in applying, please submit your cover letter and resume through the form below or email to firstname.lastname@example.org.
- Use “Payor Contracting Operations Analyst” as the subject.
- Applicants under consideration will be scheduled for a Skype or FaceTime interview. Successful first round candidates will be invited to interview in person.
We regret we are not in position to personally respond to all applicants.
About Proliance Surgeons:
Proliance Surgeons is one of the largest surgical practices in the country, with 200 board-certified physicians providing treatment at more than 60 care centers in Washington State. Our range of specialties includes orthopaedics, sports medicine, ear nose & throat, general surgery, ophthalmology, urology and more. Many of our surgeries are performed at our own outpatient surgery centers - where costs are often lower and recovery times faster than at a hospital. Patients return home the day of their surgery to begin healing and rehabilitation and get back to doing what they love, faster. Proliance physicians helped more than 600,000 patients last year alone, and performed over 77,000 surgeries. See www.proliancesurgeons.com for more information about our practice.