Senior Payor Contract Analyst
About The Position
The Senior Payor Contract Analyst works under the general supervision of the Payor Contracting Director and oversees and manages commercial and Medicare Advantage payor contracts. The position serves in provider relations and roster management for internal and external stakeholders, collaborating with Medical Affairs provider credentialing, Revenue Cycle, Finance, and external commercial insurance payor representatives. The analyst works with internal and external partners to understand and improve provider rosters, provider data and configuration, claims denials, operational issues, and payor contractual requirements. The role conducts financial analyses and cost comparisons for contract negotiations, negotiates single case agreements, supports the Payor Contracting Director in negotiations, and is responsible for facility credentialing.
Requirements
- Bachelor's degree, or a high school diploma or GED and 4–6 years of experience in contract management, provider relations, or provider enrollment 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.
- EPICPA-EPIC Provider Administrator - DHHA - Denver Health and Hospital Authority license.
- Excellent verbal and written communication, leadership, delegation, collaboration, and interpersonal skills, including the ability to articulate 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; general knowledge of software applications and their capabilities.
- Working knowledge of Microsoft Word, Excel, PowerPoint, and Outlook, and other applications as needed.
- Ability to independently define problems, develop relevant solutions, collect data, establish facts, and draw valid conclusions.
Responsibilities
- Ensure the payor contracting department has relevant knowledge of commercial and Medicare Advantage payor enrollment requirements, and develop and maintain provider roster issue processes and a mechanism 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 compliance with payer standards.
- Build relationships with internal and external customers and liaise between payors and internal departments, including Revenue Cycle, Registration, Patient Access, and the Medical Staff Office, to resolve provider roster, contracting, billing, payment, and registration issues.
- Conduct financial analyses and cost comparisons for payor contract negotiations.
- Negotiate single case agreements to capture 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 7 holidays.
- 100% paid parental leave for up to 6 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 and perks on brands, travel, and more.
- Tuition reimbursement and assistance.
- Education, coaching, and professional development opportunities through the Workforce Development Center.
- Professional clinical advancement program and shared governance.
- Public Service Loan Forgiveness eligibility, with free student loan coaching and assistance navigating the program.
- National Health Service Corps and Colorado Health Service Corps eligibility.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
