Senior Payer Analyst / Managed Care Contracting

Description

Job Schedule: Full Time

Standard Hours: 40

Job Shift: Shift 1

Shift Details:

Work where every moment matters.

Every day, over 38,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.

With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary:

Reporting directly to the Manager of Payer Contract Analytics, the Sr. Payer Analyst develops a modeling process for negotiated rate changes with Managed Care payors for hospital services. Develops payment related tools such as payer rate grids and fee schedule comparison databases. Responds to contract related inquiries within established timeframes. Works independently to identify and correct drivers related to contract language and rate terms. Identifies and corrects issues related to contract performance. Implements and improves the contract distribution process.

Position Responsibilities:

Key Areas of Responsibility

1.Develops modeling process to maximize hospital reimbursement and ensure consistency. Recommends contract provisions and protections to minimize payer policy impacts on hospital revenue to Manager of Payer Contract Analytics.

2.Develops modeling process to benchmark reimbursement rates to Contracted Commercial, Medicare and Medicaid reimbursement levels.

3.Builds contract terms in EPIC to reflect negotiated rate changes. Works with Contract Management team to identify and correct build issues related to payment variances.

4.Develops ad hoc analysis in support of HHC and/or ICP initiatives as assigned; ensuring end results fulfill initial requests or project goals.

5.Supports hospital and physician analytics as assigned.

Working Relationships

Job Title of Individual(s) Reports To: Manager of Payer Analytics & Reporting

Internal Interaction: PFS, CFOs, Revenue Cycle, Decision Support, Other Reporting/Analytic Areas as appropriate

External Interaction: Payers

Qualifications

Education

• Minimum: BA/BS degree

• Preferred: BA/BS degree in Health Care, MIS, Finance, Statistics or Mathematics

Experience:

• Minimum: 3 years of hospital and physician contract related experience

• Preferred: 5 years of hospital and physician contract modeling related experience

Knowledge, Skills and Ability Requirements:

• Knowledge regarding current and evolving provider payment methodologies with a focus on hospital

• Knowledge of governmental payment structures

• Experience with contract modeling software as well as other financial software including hospital information systems and reporting tools (MedAssets, EPIC) preferred

• Experience working with large data sets preferred

• Excel ability required, SQL experience a plus

• Demonstrated knowledge on billing and coding is required as well as broad knowledge of health care finance and/or accounting issues

• Knowledge of cost accounting and EPSi highly desired

• Strong interpersonal and communication skills essential as well as demonstrated ability to work collaboratively across functional areas

• Advanced analytic and problem-solving skills

• Customer service focus

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.