Payer Contract Analyst

Altru Health System; Grand Forks (ND); On-site; USD 60,715 - 91,083; Full time

Job summary

Altru Health System is hiring a Payer Contract Analyst to develop and optimize reporting for contract performance and reimbursement trends. You will work with the Finance team to create data collection tools, analyze financial impact, and monitor payer contracts and guidelines across commercial payers.

The role requires at least 1 year of related experience, an associates degree in business or related field (bachelors preferred), and proficient English communication.

Qualifications

• Associates degree in Business or related field is required.
• Bachelor's degree in Business is preferred.
• Minimum of 1 year related experience.
• English proficiency in reading, writing, and speaking.

Responsibilities

• Assists with preparation of reports and report analysis for reimbursement and utilization issues.
• Monitors changes to payer contracts and payer guidelines to educate staff prior to changes.
• Analyzes payer reimbursement calculations and charges to validate payments from government and commercial payers.
• Develops and maintains knowledge on risk scoring, episodes of care, bundled payments and related reimbursement trends.
• Summarizes data and findings for internal/external audiences with graphical data, reports, or statistical analysis.
• Keeps up to date with third party and government payer rules, regulations and payment policies.
• Assists with Medicare cost report preparation and knowledge.
• Performs internal audits to ensure billing compliance and optimal reimbursement.
• Other duties as assigned.

Education

Associates - Business OR Associates - Related Field

Bachelors - Business

Job description

Everything we do is underscored by a why — and that why is one another.

Location:

Altru Health System PO Box 6002 Grand Forks, ND 58201 Pay Range: $60,715.20 - $91,083.20

Summary:

The Payer Contract Analyst has responsibility for development and optimization of reporting and analysis for contract performance, reimbursement trends, payer policy changes, and financial performance. This position will work within the Finance team to develop tools for data collection for payment models and trends and analyze their financial impact on the organization. This position will monitor changes in payer contracts and guidelines, for both commercial and commercial payers, to educate and act as a resource for the organization and assist in implementation of changes.

Essential Job Functions:

• Assists with preparation of reports and report analysis for reimbursement and utilization issues. Completes financial analysis regarding reimbursement and compliance issues or opportunities.
• Monitors all changes to payer contracts and payer guidelines to provide education to appropriate staff prior to changes to ensure timely implementation of upcoming changes.
• Analyzes payer reimbursement calculations and charges to validate payments from government and commercial payers to ensure compliance with billing and coding guidelines. Assists with development and analysis of contract proposals and performance. Works with third party payers to address any payment discrepancies or billing issues.
• Develops and maintains expert level of knowledge on risk scoring, episodes of care, bundled payments and other industry specific trends in reimbursement methodology.
• Summarizes data and findings for internal and/or external audiences. Creates graphical data, written reports, and/or statistical analysis to explain trends and opportunities.
• Performs research and stays up to date regarding all third party and government payer rules, regulations, and payment policies. Assists with communication and education with appropriate staff to ensure compliance with changes. Monitors trends for inpatient, outpatient, and physician billing, coding and payment methodology.
• Assists in preparation of reporting for Medicare cost report. Develops and maintains expert level of knowledge of Medicare guidelines, reimbursement methods and cost report.
• Performs internal audits to ensure billing compliance and optimal reimbursement. Performs department specific analysis of charges to determine correct charges are being utilized. Works with staff to correct trending issues and discrepancies and determine any opportunities for process improvements in billing, strategic pricing, and documentation. Performs research and analysis for new and updated procedures to ensure billing and coding compliance.
• Performs other duties as assigned or needed to meet the needs of the department/organization.

Education:

• Required: Associates - Business- OR -Associates - Related Field
• Preferred: Bachelors - Business

Work Experience:

• Required: A minimum of 1 year Related Experience

Language Requirements:

This position requires proficiency in reading, writing, and speaking English to ensure effective communication in the workplace and with patients, families, and team members.

Physical Demands :

• Sit: Continuously (67-100%)
• Stand: Occasionally (5-33%)
• Walk: Occasionally (5-33%)
• Stoop/Bend: Occasionally (5-33%)
• Reach: Frequently (34-66%)
• Crawl: Not Applicable
• Squat/Crouch/Kneel: Occasionally (5-33%)
• Twist: Occasionally (5-33%)
• Handle/Finger/Feel: Continuously (67-100%)
• See: Continuously (67-100%)
• Hear: Continuously (67-100%)

Weight Demands:

• Lift -Floor to Waist Level: Sedentary (<10 pounds)
• Carry: Sedentary (<10 pounds)
• Push/Pull: Sedentary (<10 pounds)
• Slide/Transfer: Not Applicable

Working Conditions:

• Indoor: Continuously (67-100%)
• Outdoor: Not Applicable
• Extreme Temperature: Not Applicable

Driving Requirement Definitions:

• Professional Drivers: Persons who drive as their main responsibility OR transport passengers or hazardous materials.
• Frequent Drivers: Persons whose main responsibility is not driving, but drive daily or almost daily.
• Occasional Drivers: Persons who drive from once per month to as frequently as once per week.
• Infrequent Drivers: Persons who are generally not expected to drive.

Driving Requirement for this position:

Infrequent DriverReference ID: R7963

Making a real difference. For one another.

To take the best care of our patients and community — including friends, family, and neighbors — we need people who are committed to growth, excellence, and one another.

At Altru, you’ll find a culture where support and teamwork are at the heart of what we do. You’ll have opportunities to advance your skills, work with the latest technologies, experience the fulfillment that comes from giving back, and take your career wherever you want it to go.

Join our team and be a part of a small community with a big heart.

Altru offers a comprehensive benefits package to its full- and part-time employees. Excellent benefits include a health plan and 401(k) retirement plan. Other benefits include a dental plan, vision plan, life and disability insurance, education assistance, paid time off (PTO)