Payor Contract Analyst, Intermediate

About the role

UPMC Payor Contracts Team is responsible for the ongoing negotiation of the UPMC hospitals and physician contracts. The Payor Contracts Analyst - Intermediate is responsible for evaluating and providing recommendations regarding health insurance provider contracts and relationships. This is a regular, full-time position that primarily works daylight hours, Monday through Friday. A perk of this position includes a hybrid work schedule.

Responsibilities

• Prepare advanced reimbursement models, including but not limited to, case and per diem rates, cost and day outliers, and advanced fee-for-service fee schedules for the purpose of determining payor contract proposed terms as compared to current contractual terms and other comparable payor contract terms.
• Data mine provider and payor financial and operational data population for analysis. Define the necessary data elements required for the project.
• Perform testing on advanced payor claims to ensure accuracy and compliance to contract terms.
• Maintains Top Ten Payor Detail Matrix and Contracted Insurance Matrix for all hospitals.
• Researches and responds to moderately complex internal UPMC entities and payor questions as they relate to contracts.
• Coordinate the process of research on insurance companies and other payors medical policies, billing policies, contracted reimbursement rates and related issues to assist in evaluating and modeling payor financial performance in order to maintain or develop new or enhanced revenue streams.
• Verification of payor rate schedule updates for compliance to contract terms.
• Interact as a team member of the department to achieve maximum outcomes.
• Prepares financial and operational activity reports to support contractual decisions including assumptions and observations.

Qualifications

• Bachelor's degree and one year of related work experience OR associate's degree and three years of related work experience OR High School Diploma and five years of related work experience required.
• Prior experience within a health care related role is preferred.
• Solid understanding of healthcare terminology, insurance contract language and hospital or professional payment methodologies including a general understanding of Medicare and PA Medicaid reimbursement.
• Working knowledge of Microsoft Excel and Word.
• Must have solid analytical skills.
• Must have solid written and oral communication skills.
• Must be an effective team player.