Contract Management Analyst

Location: United States

Duration: Permanent

Responsibilities:

• A Bachelor’s degree in Business, Finance, Healthcare, or related field, or a combination of relevant education and experience
• Five or more years of experience in a multi-facility health system in either: Finance operations like managed care (preferred), cost accounting, planning, or budget, Revenue cycle operations such as billing, collections, or payment processing
• Requires detailed knowledge of hospital and physician complex reimbursement methodologies, particularly fee for service commercial contracts as well as Medicare and Medicaid. Value based care (VBC) risk reimbursement structure knowledge preferred but not required
• Excellent understanding of contract language and rate terms, physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws
• Proficient understanding of MS-DRG, APC, EAPG, case rate, stoploss, carveout reimbursement methodologies
• Proficient understanding of Revenue Code and CPT coding in a clinical/hospital/ASC/physician office setting
• Proficient manage care contract rate interpretation skills
• Experience with payer compliance review including underpayment variances and denial management highly desirable
• Preferred certification in Epic Resolute Expected Reimbursement Contracts Administration and NThrive Contract Management system
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