Sr Pay/Provid Contract Analyst

University of Rochester•Town of Brighton, NY

7d•$61,000 - $85,400

About The Position

The Sr. Payer Provider Contract Analyst conducts specialized and complex analyses of payer issues impact on the University of Rochester Medical Faculty Group (URMFG) revenue cycle process. The individual identifies trends, investigates and makes recommendations to improve revenue. The role involves analyzing payer policies, including interpretation of administrative and clinical edit programs, creating communications to management, departments, and physicians, and representing URMFG with payers. The position requires comprehensive knowledge of payer reimbursement methodologies, rules, regulations, and contract terms, and is responsible for activities related to URMC’s largest payers and URMFG’s larger and/or more complex departments.

Requirements

Bachelor's degree and 5 years of experience with medical practice billing/coding/terminology or relevant experience
Equivalent combination of education and experience

Nice To Haves

Excellent organizational and problem-solving skills
Excellent customer service & communication skills (both oral and written)
Ability to work in a team with all levels of management and staff
Experience with Microsoft Office products, with emphasis on Excel
EPIC fluency
Tableau reporting knowledge
Demonstrated understanding of CMS and AMA CPT

Responsibilities

Independently research and resolve payer issues including prior authorizations, denials management and payer policy determinations.
Interpret reports for monitoring negotiated rate variances and recoveries.
Facilitate meetings with payers, United Business Office (UBO), senior administrators and providers to resolve complex revenue/payer issues.
Represent URMFG to external payer representatives, managers, Medical Directors and Compliance.
Work in conjunction with URMC Payer Contracting & Reimbursement managers in a team approach to payer issues.
Develop, compile, and communicate reports that monitor payer issues to internal and external stakeholders.
Track financial recoveries to completion and convey processes and results to peer Revenue Cycle Advisors (RCA).
Provide advice to RCAs & UBO staff regarding payer reimbursement.
Identify and present innovative improvements to increase operational efficiencies and revenue.
Ensure projects are appropriately documented using Issue Trak application.
Maintain expert knowledge of commercial & government payer reimbursement, rules, regulations, coding, contract terms and conditions.
Provide consultation to Associate Director regarding payer/financial developments for planning, control and analytical processes.
Work with Compliance Analysts, Office of Counsel, and Medical Staff Office managers regarding credentialing and payer provider file issues.
Provide input in the development and implementation of systems and/or new technologies, e.g. EPIC.
Mentor, train & assist Payer Provider Contract Analyst II staff with ad hoc projects/report design.
Responsible for special projects involving reimbursement and finance.
Establish and adhere to project timelines and activity plans.
Assist in developing payer relations policy/procedure.