Provider Contracting Analyst-Payor Relations

Job Objective:

Supports the Payor Relations department in overseeing contracting, distribution of health plan issued payor updates, pricing/payment analysis, Letter of Agreement requests and other related health plan initiatives. Responsible for the timely monitoring of new and existing contracts, providing appropriate analytical support to Payor Relations department to support contract decision-making.

Essential Responsibilities:

• Demonstrates compliance with Code of Conduct and compliance policies and takes action to resolve compliance questions or concerns and report suspected violations.
• Supports Payor Relations Departments in managing/tracking upcoming contract renewals and Letter of Agreement requests. 
• Runs volume and payor analysis reports in excel Power BI, and/or Epic, to identify and monitor payor trends to support contract negotiation efforts. 
• Manages payor correspondence and distributes to relevant department stakeholders throughout the organization. 
• Manages online inbox for patient questions that come in regarding insurance and benefit coverage. 
• Maintains current with all regulatory issues affecting billing, reimbursement and compliance.
• Participates in all regulatory and compliance continuing education for healthcare and hospital services.
• Builds and maintains strong positive relationships with payor partners to ensure ongoing collaboration and alignment with objectives.
• Oversees the administration of payor contracts, including renewals, amendments, and compliance with contract terms.
• Supports leadership in ongoing managed care contracting initiatives, including communicating key contract milestones/proposals to plans during negotiations. 
• Addresses and resolves any health plan disputes and issues that arise with payors, ensuring minimal disruption to operations and financial stability.
• Identifies problems, conceptualizes resolutions to the problems and escalates to the appropriate stakeholders for review.
• Performs other duties as assigned.  

Essential Skils:

• Written and verbal communication skills
• Ability to maintain positive interpersonal relationships
• Ability to utilize PC applications for financial analysis, database development and report generation
• Ability to interpret a variety of regulations and deal with multiple patient accounting systems, ancillary systems
• Ability to use Microsoft Office Suite, specifically Excel for data analysis (pivot tables, Vlookups, etc.)
• In depth knowledge of various commercial, Medicare Advantage, and Medi-Cal Managed Care plan offerings including PPO, HMO, POS, EPO, ext
• In depth knowledge of health care pricing and reimbursement methodologies
• Ability to speak in front of groups with confidence and clarity
• Ability to effectively communicate in a positive and professional manner
• Basic knowledge of CMS coverage requirements and types of Medicare coverage (Part A/Part B/Part C, etc.)
• Knowledge of health plan contracts, hospital revenue cycle functions and payor compliance