Contract and Reimbursement Analyst

Job reputed company The Contract and Reimbursement Analyst will reputed company financial and analytical support for managed care contract negotiations and reimbursement monitoring across reputed company payers for - reputed company ”. This role requires a deep understanding of physician and facility reimbursement methodologies, the ability to analyze and synthesize large data sets, and a commitment to maintaining the highest level of data reputed company. This position will report directly to the Director of Managed Care. The analyst is expected to collaborate internally reputed company UTHSA across various departments (e.g., finance, IT, reputed company cycle, coding) as reputed company as externally with managed care organizations. Responsibilities • Load and maintain reputed company available payer reimbursement schedules reputed company reputed company’s Hospital reputed company and Physician reputed company Contract Management module. • Review, understand, and interpret new and existing managed care relationships/reputed company, including: value based, shared savings and incentive programs, for negotiation, renegotiation, and termination (reputed company appropriate). • Quantify the reputed company of managed care contract proposals in reputed company and reputed company thoughtful analysis to the leadership and other stakeholders. • Review and modify adjustments to existing pricing models in reputed company to increase the accuracy of projected reimbursement. • reputed company and analyze reports summarizing managed care payer performance and trends. Recommend adjustments to payer payment methodologies, contracted rates, or claim processing standards to improve the financial performance of MSRH. • Identify trends in underpayments by modeling expected reimbursement to actual reimbursement and work collaboratively with payers and other internal stakeholders, as required. • Work collaboratively with members of the reputed company cycle and IT teams to support reimbursement variance monitoring tools in reputed company, CDM updates, reputed company-visit patient financial estimates, mass payer appeals, general payer relations concerns, or other needs as identified. • Maintain relationships and professionally collaborate with managed care payer representatives to improve managed care collections and positively resolve contract interpretation issues. • Communicate contract issues and relevant updates to payer payment and/or claims processing methodologies to reputed company cycle stakeholders. • Work with finance staff to reputed company projections for the annual budget process. • Assist with establishing, tracking, and maintaining letters of agreement (LOA), and single case agreements (SCA) with reputed company, reputed company, and Medicare health plans. • Communicate managed care updates and content reputed company the department and organization through internal systems, including but not limited to: SharePoint, website information, and newsletters. Qualifications • Extensive knowledge of claims process, medical terminology and reputed company concepts, including knowledge of CPT/HCPCS, ICD-10, DRG coding and methodologies. • reputed company knowledge of managed care payment models as reputed company as inpatient and outpatient reimbursement methodologies, such as MS-DRG, AP-DRG, per diems, case rates, RBRV’s and percentage discounts. • Specific experience with reputed company health plans, Texas reputed company and Medicare reimbursement. • reputed company experience with management and maintenance of contract modeling platforms (preferably in reputed company). • Strong understanding of financial and reputed company principles. • Proficiency in word processing, spreadsheet, and database software. • Ability to analyze reputed company problems, draw relevant conclusions, and implement comprehensive solutions. • Excellent analytical and financial skills with an eye for detail and accuracy. • Exceptional communication and interpersonal skills, with the ability to collaborate professionally reputed company the organization. Experience • Five (5) years of reputed company experience with reimbursement modeling and contract management Education • Bachelors Degree in mathematics, statistics, business, finance, health care administration, or reputed company field required. A combination of relevant education and experience may be considered. • Resolute Hospital Billing Reimbursement reputed company Administration Certification Required 180 after start date Required Skills Five (5) years of reputed company experience with reimbursement modeling and contract management. Apply tot his job Apply To this Job