Payer Contract Analyst

CarepathRx-posted 3 months ago
Full-time • Entry Level
1,001-5,000 employees
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The Payer Contract Analyst (PCA) is responsible for proper contracting and revenue cycle management support. Ensures contracting requirements are met and provides analysis, problem resolution, auditing, reporting and process recommendations for optimal outcomes. The PCA will assist Contracting with contacting payers to receive relevant information for billing. The ideal candidate will have knowledge of home infusion, medical billing practices, and payer reimbursement guidelines, as well as strong communication and problem-solving skills.

  • Assist RCM team with escalated systemic billing/collection issues.
  • Assist with network contracting by making calls to payors, follow-up support and documentation requirements.
  • Supports the payer contract team ensuring that contract requirements are appropriately met, contracts are kept up-to-date in the pharmacy electronic files.
  • Assists in payer negotiation activities.
  • Respond to questions surrounding contracts (reimbursement, benefit design, contracted services).
  • Monitors performance of the payer process to ensure correct policy and procedures are being followed.
  • Acts as the subject matter expert in the requirements, rules and regulations of third-party and government payers.
  • Understands eligibility requirements and authorization requirements of insurance company plans, Medicare, and Medicaid, and how each program/payer reimburses.
  • Assist Payer Contracting team with updating Contract folders as well as completing contract cover sheets and other special projects as required.
  • Manages defined processes to ensure effectiveness and efficiency in the process and maintains databases, including contract/fee schedule rate updates, to ensure proper tracking, audits, reporting, analysis and resolution occurs timely and appropriately.
  • Assist Revenue Cycle Analyst by assuming some of the regularly scheduled reports; assist in meetings to design newly requested reports as required by the Revenue Cycle Department.
  • Assist with drug profitability requests.
  • Ensure accurate and timely completion of all assigned and projects.
  • Other duties as assigned.
  • Strong knowledge of payor contracting and managed care programs.
  • Excellent interpersonal, organizational, communication and effective problem-solving skills.
  • Attention to detail is critical to the success of this position.
  • Must be able to manage multiple projects simultaneously.
  • Must be willing and able to work independently or in a collaborative setting, based on project need.
  • Must be able to communicate effectively.
  • Discretion in handling confidential company information.
  • Ability to effectively approach problem solving.
  • Excel and Power BI experience preferred.
  • Knowledge of reimbursement practice and electronic claims processing is preferred.
  • Preferred experience in pharmacy and health insurance where the work performed required a basic knowledge of contracts, third party insurance, HIPAA, and governmental payment knowledge of Medicare and Medicaid.
  • Bachelor’s degree or equivalent preferred.
  • Previous relevant experience can be substituted in lieu of degree.
  • Medical, dental and vision coverage effective 1st of the month following date of hire.
  • Flexible spending.
  • Company-paid life insurance and short-term disability.
  • Voluntary benefits.
  • 401(k) with Company Match.
  • Paid Time Off and Volunteer Time Off.
  • Paid Company Holidays.
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