Payor Contracting Analyst

General Summary

Performs and/or supervises the performance of Payor contract review, to address financial, pricing and operational issue resolution. Works with internal departments to provide implementation and education of new contracts, as well as changes to existing contracts. Work collaboratively with other WellSpan departments to identify and collect underpayments from third party payors. Assists with maintenance of accurate expected payment rates in system applications and reference tools.

Duties and Responsibilities

Essential Functions:

• Maintains a proficiency of payment terms and conditions of Commercial and Government contracts to ensure that all are accurately represented in all applicable system applications and reference documents. Serves as a lead with assigned Payors to address contract and Payor related issues on behalf of internal departments.
• Works with various system applications, and in collaboration with other WellSpan departments, to identify underpaid accounts. When denial trends are identified where payments are deficient, works with payor to resolve issues and collect additional monies due. Timely resolves underpayments or denial trends, while addressing any root causes that are contributing to incorrect payments.
• Investigates revenue processes to ensure system is optimizing reimbursement while maintaining compliance with applicable rules and policies. Assists with recommended action steps and works collaboratively with other departments to improve processes when control, operational weaknesses and/or compliance issues are found. Performs follow up reviews to ensure action steps were met. Develops ways to trend issues.
• Investigates billing system errors and develops corrective action(s) that will ensure appropriate reimbursement. Follows through with the department to ensure compliance with changes.
• Communicates & distributes new payor contract terms and conditions, changes, and payor notifications to internal stakeholders. Prepares and provides necessary paperwork and education with internal stakeholders on new payment terms and changes to ensure operational processes are understood and implemented.
• Assists with the development of the quarterly yield report as needed, which includes investigation of potential errors to ensure accurate yield performance by Payor. Prepares variance analysis and supports senior analyst with analysis of information as needed. This also includes the development of payor concentration reports and other requests for various reports.
• Payor data and policy collection, and assistance with financial analysis, as necessary for third party contract negotiations.
• Maintains working knowledge of Patient Accounting systems utilized by the System, as applicable, to research root causes of underpayments and denials.
• Manages special projects as assigned by the Director of Managed Care.
• Seeks and assists with identifying performance improvement initiatives within the Payor Contracting department to improve efficiency.
• Maintains various contract management systems in collaboration with the Revenue Management and Information Technology departments.

Common Expectations:

• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Enhances professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Travel Requirements:

• Estimated Amount: - Travel required.

Qualifications

Minimum Education:

• High School Diploma or GED Required
• Bachelors Degree Preferred

Work Experience:

• 2 years In Billing/Revenue Cycle Functions, Payor Contracting, Business Operations, or HealthCare Finance. Required

Courses and Training:

• Business/Accounting, Finance or Management. Upon Hire Preferred

Knowledge, Skills, and Abilities:

• Proficient in Excel and Microsoft office.
• Excellent written & oral communication skills.
• Basic computer skills.
• Works effectively in a team environment.

Benefits Offered:
Comprehensive health benefits
Flexible spending and health savings accounts
Retirement savings plan
Paid time off (PTO)
Short-term disability
Education assistance
Financial education and support, including DailyPay
Wellness and Wellbeing programs
Caregiver support via Wellthy
Childcare referral service via Wellthy