Implements new payer contracts and contract changes as directed.
Cultivates and maintains payer relationships as well as internal customer relationships.
The analyst develops and maintains departmental resources and tools and assists with payer payment management and reporting.
Interprets payer contract terms and payment methodologies for the creation and ongoing maintenance and programming of Epic’s financial system and Contract Management tool to ensure accurate calculation of expected payments based on negotiated contract terms at the time of billing for professional, hospital and ancillary services.
Supports contract negotiations through review of contract language, development of new payment models, modeling of proposed contract terms and rates, making recommendations as appropriate to department management.
Interacts with internal and external parties regarding communication / questions about rates and terms, rate structure and development and reconciliation of contract provisions and disputes.
Responsible for the ongoing, timely maintenance of professional, hospital and ancillary provider fee schedules.
Audit payer claims to ensure accuracy of system build and compliance with contract terms, investigating systematic payment issues identified by department analyses or communicated by leadership.

Demonstrated experience working in healthcare or managed care setting with a specific background in complex managed care and government contract modeling, building and maintenance for providers including health systems, physicians, hospital organizations and other ancillary facilities.
Ability to obtain Epic Resolute Hospital and Professional Billing Expected Reimbursement Contract Certifications within three months of hire date and maintain while in this role.
Demonstrated patient accounting experience
Demonstrated extensive experience with healthcare reimbursement methodologies (managed care and government payers).
Strong experience with MS Excel, Epic and with modeling and managing professional provider fee schedules

generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged

Contract Analyst

Key skills