Payor Contracting Analyst - Population Health

York, PA | Professional | Tracking Code: 61046

Position Summary:

 

General Summary:
Under the general supervision of the Senior Manager-Payor Contracting Operations, Population Health & Payor Contracting, 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:

1 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.
2 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.
3 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.
4 Investigates billing system errors and develops corrective action(s) that will ensure appropriate reimbursement. Follows through with the department to ensure compliance with changes.
5 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.
6 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.
7 Payor data and policy collection, and assistance with financial analysis, as necessary for third party contract negotiations.
8 Maintains working knowledge of Patient Accounting systems utilized by the System, as applicable, to research root causes of underpayments and denials.
9 Manages special projects as assigned by the Director of Managed Care.
10 Seeks and assists with identifying performance improvement initiatives within the Payor Contracting department to improve efficiency.
11 Maintains various contract management systems in collaboration with the Revenue Management and Information Technology departments.

 

Required Skills

 

Minimum Education

Bachelor's Degree or 5 years in Business Operations, Audit or HealthCare Finance.

Minimum Experience

2 years in Business Operations, Audit or HealthCare Finance. Must have Excellent written & oral communication skills; basic computer skills. Works effectively in a team environment.

Ideal candidate has Business/Accounting, Finance or Management background and is proficient in Excel and Microsoft office.

 

 

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Why WellSpan Health?

WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization comprises a multispecialty medical group of more than 1,500 physicians and advanced practice clinicians, a regional behavioral health organization, a home care organization, eight respected hospitals, more than 19,000 employees and 170 patient care locations. WellSpan is a charitable, mission-driven organization committed to exceptional care for all, lifelong wellness and healthy communities. We are committed to transforming the health of the communities we serve and to educating the next generation of clinicians, staff and leaders.

Employment Benefits

  • Sign-on incentives for new employees (click here for details)
  • Medical, dental and vision insurance
  • Life and accidental death insurance
  • Supplemental life insurance
  • Retirement savings plan
  • Paid time off (PTO)
  • PTO bridging
  • Short-term disability
  • Educational assistance
  • Forgivable loan
  • Flexible spending
  • Credit union
  • Employee recreational activities
  • Childcare
  • Complimentary medicine discounts

Diversity & Inclusion

Know, Respect, Include

WellSpan Health believes that diversity includes all the human characteristics that make each of us similar as well as different. We strive to make every person feel welcomed, respected and valued, while creating a safe and inclusive environment where we all have the individual freedom to express our uniqueness in a respectful manner.

WellSpan Health is an equal opportunity employer. Employment selection and related decisions are made without regard to sex, race, age, disability, religion, national origin, color or any other protected class. WellSpan Health does, however, have a tobacco-free/nicotine-free hiring policy.

Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more — within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)