Senior Payor Contract Analyst

Denver Health and Hospital Authority•Denver, CO

About The Position

The Senior Payor Contract Analyst oversees and manages commercial and Medicare Advantage payor contracts and performs provider relations and roster management for internal and external stakeholders. Reporting to the Payor Contracting Director, the role works closely with Medical Affairs provider credentialing, Revenue Cycle, Finance, and external commercial insurance payor representatives. It collaborates across these groups to improve provider rosters and data, provider configuration, claims denials, operational issues, and understanding of contractual requirements.

Requirements

Bachelor’s degree, or a high school diploma or GED and 4–6 years of contract management, provider relations, or provider enrollment experience in lieu of a bachelor’s degree.
4–6 years of experience in provider relations, payor contracting, provider enrollment, payor configuration, or provider-facility credentialing.
Required license/credential: EPICPA-EPIC Provider Administrator – DHHA – Denver Health and Hospital Authority.
Excellent verbal and written communication, leadership, delegation, collaboration, and interpersonal skills.
Ability to explain complex issues to a broad audience.
Strong knowledge of commercial and Managed Medicare contracts.
Understanding of provider data fields, including open/closed panel, taxonomy, hospital-based, PCP, specialist, provider directories, service lines, and CPT procedures.
Working knowledge of billing, reimbursement, and general revenue cycle management strategies.
Excellent organizational skills, attention to detail, and ability to multitask.
Ability to use software applications and access, update, correct, or delete data in information systems.
General knowledge of software applications and their capabilities, including Microsoft Word, Excel, PowerPoint, and Outlook.
Ability to independently define problems, develop relevant solutions, collect data, establish facts, and draw valid conclusions.

Responsibilities

Maintain the department’s knowledge of commercial and Medicare Advantage payor enrollment requirements, manage provider roster issues, and develop mechanisms for resolving enrollment issues.
Collaborate with the Medical Staff Office to collect and submit accurate provider directory information; update, audit, and send provider rosters to commercial payers in accordance with payer standards.
Build relationships with internal and external customers and serve as a liaison between payors and departments including Revenue Cycle, Registration, Patient Access, and the Medical Staff Office to resolve provider roster, contracting, billing, payment, and registration issues.
Conduct financial analysis and cost comparisons for payor contract negotiations.
Negotiate single-case agreements to obtain financial reimbursement from non-contracted entities.
Support the Payor Contracting Director in contract negotiations.
Manage facility credentialing.
Complete assigned special projects and research.

Benefits

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick time, and seven holidays.
100% paid parental leave for up to six weeks.
Immediate eligibility for retirement plans with employer contributions up to 9.5%.
Medical, dental, and vision plans, plus employer-paid disability and life insurance.
Well-being programs, including an on-site employee fitness center and the RESTORE Center.
Free RTD EcoPass for public transportation.
Childcare discount programs and discounts on brands and travel.
Tuition reimbursement and assistance.
Education, coaching, and professional development opportunities through the Workforce Development Center.
Career advancement pathways and professional clinical advancement and shared governance programs.
Public Service Loan Forgiveness (PSLF) eligibility, free student loan coaching, and assistance navigating the PSLF program.
National Health Service Corps (NHSC) and Colorado Health Service Corps (CHSC) eligibility.