Contract & Reimbursement Analyst II

Essential Duties And Responsibilities

• Ensures las contract rates and terms are available.
• Requests clarification from clients on missing information or reimbursement interpretations.
• Builds stop-loss definitions.
• Confirms correct plan code affiliations.
• Identifies payer product line evolution and updates the pricing portal accordingly.

Special Projects

• Creates price uploads following model approval.
• Builds client pricing transparency files for online publication under federal requirements.
• Affords assistance with room-rate and lesser-of analyses.

Quality Assurance Support

• Compares annual pricing models to ensure data integrity.
• Troubleshoots process issues for root cause.
• Affords assistance with creation and implementation of QA programs.
• Communicates updates, issues, and concerns to leadership.
• Communicates with clients to confirm contract terms and intentions.
• Performs other duties as assigned.

Remote and Hybrid Positions

Remote and Hybrid positions require a home internet connection that meets the company’s upload and download speed criteria.

Required Education and Knowledge

• Bachelor’s degree or equivalent experience.
• 3–5 years of hospital managed care contracting experience.
• Extensive expertise in reimbursement methodologies across hospitals, physicians, ancillary services, and health plans.
• Comprehensive understanding of DRGs, CPTs, Revenue Codes, Charge Codes, and ICDs, as well as advanced analytical concepts and procedures.
• In-depth knowledge of Medicaid and Medicare fee schedules.
• Solid background in healthcare finance and business principles.

Required Skills

• Exceptional abilities in organizing and keeping thorough records.
• Outstanding skills in both spoken and written communication.
• Advanced proficiency in interpreting and analyzing contracts.
• Skilled in using Microsoft Office tools such as Excel, Word, Outlook, Visio, and Teams.
• Excellent at delivering presentations and building relationships.
• Capable of juggling multiple tasks, applying analytical thinking, making decisions, mapping data, and solving complex problems.
• Effective project management, strong problem-solving, and mathematical capabilities.

Benefits

• Medical, Dental & Vision Insurance.
• 401K (100% match for the first 3% & 50% match for the next 2%).
• 15 days of PTO.
• 7 paid Holidays.
• 1 Floating holidays.
• Elevate Day (floating holiday).
• Pet Insurance.
• Employee referral bonus program.
• Teamwork: We believe in teamwork and having fun together.
• Career Growth: Gain great experience to promote to higher roles.

Pay

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training.