Payor Contracting Analyst

Healthcare Outcomes Performance Co. (HOPCo) • Phoenix, AZ

18h • Remote

About The Position

This is a remote position for a Payor Contracting Analyst. The role requires a strong understanding of healthcare analytics, physician reimbursement, and CMS regulations. The analyst will be responsible for various analytical tasks related to physician contracts, utilization, and costs, and will need to demonstrate excellent problem-solving and critical thinking skills.

Requirements

• 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.
• Knowledge of physician reimbursement.
• Knowledge of provider billing practices.
• Knowledge of CPT codes, modifier rules, CMS payment policies.
• Skill in effective data collection and analysis.
• Skill in designing analyses and appropriate reports.
• High-level attention to detail, accuracy, and organization skills.
• 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.
• Excellent critical thinking, troubleshooting, and analytical skills.

Nice To Haves

• Familiarity with value-based care payment models and industry trends.
• Familiarity with managed care products and services.
• Familiar with a variety of concepts, practices, and procedures in the field of managed care and practice management.

Responsibilities

• Demonstrate thorough knowledge of CMS regulations and reimbursement methodologies relevant to professional claims.
• Analyze physician contracts, utilization, and costs.
• Conduct medical cost trend analysis.
• Problem-solve and come forward with recommendations.
• Stay on task with minimal supervision.
• Prepare and understand functional and technical specifications.
• Analyze problems and interpret information.
• Prioritize and reprioritize tasks as necessary.
• Multi-task, manage multiple projects, and meet tight deadlines.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level