Payor Contracting Analyst

Healthcare Outcomes Performance CompanyPhoenix, ArizonaOn-siteFull-timeMid level, 2–5 yearsListed 1 hour ago

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About this role

Remote position

Benefits :

- Competitive Health & Welfare Benefits

- HSA with qualifying HDHP plans with company match

- 401k plan after 6 months of service with company match (Part-time employees included)

- Employee Assistance Program that is available 24/7 to provide support

- Employee Appreciation Days

- Employee Wellness Events

Minimum Qualifications:

- Minimum of three years of experience working in an analytic role in a healthcare environment (payor or provider) with an in-depth knowledge of physician reimbursement methodologies.

- Intermediate to advanced-level MS Excel skills (pivot tables, vlookups, conditional formulas).

- Experience using relational databases.

- Bachelors Degree in Finance or Healthcare Administration preferred.

Essential Functions

- Demonstrate thorough knowledge of CMS regulations and reimbursement methodologies relevant to professional claims.

- Familiarity with value-based care payment models and industry trends.

- Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs.

- Familiar with a variety of concepts, practices, and procedures in the field of managed care and practice management.

- Possesses strong organizational skills and careful attention to detail.

- Must be able to problem-solve and come forward with recommendations.

- Must be able to stay on task with minimal supervision.

- Excellent critical thinking, troubleshooting, and analytical skills.

KNOWLEDGE

- Knowledge of physician reimbursement.

- Knowledge of provider billing practices.

- Knowledge of CPT codes, modifier rules, CMS payment policies.

SKILLS

- Skill in effective data collection and analysis.

- Skill in designing analyses and appropriate reports.

- High-level attention to detail, accuracy, and organization skills.

ABILITIES

- Strong ability to prepared and understand functional and technical specifications.

- Ability to analyze problems and interpret information and prioritize and reprioritize, as necessary.

- Ability to work independently, and as part of a team.

- Ability to multi-task, manages multiple projects, and meets tight deadlines.