Status: Full Time
- Provide analytics to support payor contracting and be responsible for all financial analysis including contract negotiations
- Develop tools and reporting to monitor reimbursement trends, and identify opportunities for improvement
- Assist in fee schedule maintenance and contract interpretation disputes
- Responsible for analysis to support payment bundling initiatives
This position reports to the Director of Analytics and Payor Contracting.
- Conducts payor contract proposal impact analysis and modeling: assesses reimbursement trends, identifies risks, develops projections, and provides recommendations on counter proposals
- Using Excel, SQL, Access, or other data analysis tools, develops analyses to support decision making
- Responsible for organizational wide reporting of reimbursement trends
- Performs ad-hoc analysis and reporting packages on cost of care, collaborates with care centers and executives in the process
- Leads financial assessment of special projects
- 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
- Compiles and maintains charge master, billing codes, and fee schedules
- Reviews claim payments to ensure contract implementations are correct, monitors’ compliance with contractual terms
- Supports Contacting Committee with ad-hoc financial requests
- Assists in developing and implementing financial case costing methodologies
- Assists in financial assessment and financial monitoring of bundling initiatives
- Assists in developing operational flow of bundling initiatives as relates to billing, payments, and invoicing
- Mentors and trains other analysts
- 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
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, contract language, and public healthcare programs
- Strong analytical skills and familiarity with common data analytics tools including Excel, Access, SQL, 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
- Comfortable with ambiguity and able to quickly adapt to changing priorities
- Ability to lead projects and initiatives
How To Apply:
If interested in applying, please submit your cover letter and resume through this site or email to email@example.com.
- Use “Senior Payor Contracting and Financial 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.