Payor Contract Analyst, Senior

at  UPMC

UPMC Corporate is hiring a Payor Contract Analyst, Senior to join our team! This role will be a hybrid position with in office days and work from home. Typically individuals work from home three days per week. The position works Monday through Friday during the hours of 8:00 AM to 4:30 PM.
Under minimal supervision, the Payor Contract Analyst, Senior is responsible for evaluating and negotiating complex health insurance provider contracts and relationships. As well as assisting and educating intermediate and associate level staff.
Do you have prior experience within payor contracts? If so, this could be the next step in your career. Apply today!

• 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.
• Define the necessary data elements required for the project.
• Perform testing on complex payor claims to ensure accuracy and compliance to contract terms.
• Routinely develop, review and analyze statistical, cost, and financial reports for complex payor contracts.
• Researches and responds to complex internal and payor questions as they relate to contracts.
• 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.
• Supports contract negotiations through review of contract language, modeling of proposed contract terms and rates and makes recommendation as appropriate to department management.
• Negotiates select payor contracts with management direction.
• Attend meetings with payors and other UPMC entities and /or departments to resolve contract issues when requested.
• Prepares financial payor models and benchmark comparisons to support contractual decisions including assumptions, observations, conclusions and recommendations.
• Proactively identify revenue generating opportunities or risks, researches and reports on payor market trends at the local and national level.
• Performs in accordance with system-wide competencies/behaviors.
• Performs other duties as assigned.
• Bachelors degree and three years of related work experience OR Associates degree and five years of related work experience OR High School Diploma and seven years of related work experience required.
• Prior experience with urgent care providers preferred.
• Comprehensive understanding of healthcare terminology, insurance contract language and professional payment methodologies, including working knowledge of Medicare and Medicaid reimbursement.
• Proficient in Microsoft Excel and Word
• Must have strong analytical skills.
• Must have strong written and oral communication skills
• Must be an effective team player.Licensure, Certifications, and Clearances:
• Act 34