Senior Payor Contract Analyst

Denver Health • Denver, CO

1d

About The Position

We are recruiting for a motivated Senior Payor Contract Analyst to join our team! We are here for life’s journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Administration Office Job Summary Under the general supervision of the Contract Payer Manager, this role is responsible for overseeing and managing commercial and Medicare Advantage payor contracts and integration of Epic systems. This position serves in a provider relations capacity for both internal and external stakeholders. The Payer Contracting Financial Analyst works closely with the Revenue Cycle (including Hospital Physician Business Services, Coding, Patient Access, Reimbursement and other related departments), Finance department and external commercial insurance payor representatives. This position collaborates internally and externally to understand and improve provider data, provider configuration, claims denials, operational issues and payor contractual requirements.

Requirements

• Bachelor's Degree Required or High School Diploma or GED and 7-10 years of experience in contract management, provider relations or provider enrollment in lieu of bachelor's degree.
• 7-9 years in provider relations, payor contracting, provider enrollment, payor configuration or provider-facility credentialing
• EPICPA-EPIC Provider Administrator - DHHA - Denver Health and Hospital Authority
• Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills.
• Strong ability to articulate complex issues to broad audience.
• Strong knowledge of commercial and Managed Medicare contracts is required.
• Understanding of provider data fields open/closed panel, taxonomy, hospital based, PCP, Specialist, provider directories as well as services line and CPT procedures.
• Working knowledge of billing, reimbursement and general revenue cycle management strategies.
• Excellent organizational skills, detail oriented and have a strong ability to multi-task.
• Utilizes software applications and working knowledge of the following information systems to include accessing information, updating, correcting and/ or deleting data. General knowledge related to various software applications and their capabilities.
• Microsoft Office applications: Word, Excel, PowerPoint and Outlook and other applications as needed.
• Ability to independently define problems and develop relative solutions, collect data, establish facts, and draw valid conclusions.

Responsibilities

• Ensures the payor contracting department possesses relevant knowledge of commercial and Medicare Advantage payor enrollment requirements and develops and maintains provider rosters issues and a mechanism for resolving enrollment issues. (35%)
• Collaborates with Medical Staff Office to collect and submit accurate information for the provider directories; updates, audits and sends provider rosters to commercial payers in compliance with payor standards. (20%)
• Develops strong relationships with internal and external customers and serves as a liaison between payors and internal departments such as Revenue Cycle, Registration, Patient Access and Medical Staff Office to resolve issues related to provider roster issues, contracting, billing, payments and registration. (20%)
• Conducts financial analyst and cost comparison for payor contract negotiations. Negotiates single case agreements to capture financial reimbursement from non-contracted entities. Supports Payor Contracting Director in contract negotiations. (15%)
• Responsible for facility credentialing (5%)
• Completes other assigned special projects and research. (5%)

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
• Free RTD EcoPass (public transportation)
• On-site employee fitness center and wellness classes
• Childcare discount programs & exclusive perks on large brands, travel, and more
• Tuition reimbursement & assistance
• Education & development opportunities including career pathways and coaching
• Professional clinical advancement program & shared governance
• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

What This Job Offers

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