Payer Contract Analyst

Altru Health System; United States; On-site; USD 60,715 - 91,083; Full time

Benefits offered by this job

Health plan

401(k) retirement plan

Dental plan

Vision plan

Life and disability insurance

Education assistance

Paid time off

Job summary

Altru Health System is seeking a Payer Contract Analyst to develop and optimize reporting and analysis for contract performance and reimbursement trends. You will collaborate with the Finance team to create tools for data collection and analyze financial impact on the organization.

You will monitor payer contracts and guidelines for both commercial and government payers, educating staff and implementing changes as needed. Strong knowledge of Medicare and payer rules is beneficial.

Qualifications

• Associates degree in Business or related field required.
• Preferred: Bachelor's degree in Business.
• Minimum: 1 year related experience.

Responsibilities

• Assists with preparation of reports and report analysis for reimbursement and utilization issues.
• Completes financial analysis regarding reimbursement and compliance issues or opportunities.
• 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.
• Assists with development and analysis of contract proposals and performance.
• Works with third party payers to address payment discrepancies or billing issues.
• Develops knowledge on risk scoring, episodes of care, bundled payments and related trends.
• Summarizes data and findings for internal and external audiences.
• Creates graphical data, written reports, and statistical analyses to explain trends and opportunities.
• Performs research on third party and government payer rules and payment policies.

Skills

Financial analysis

Reporting & analytics

Payer contracts knowledge

Education

Associates - Business

Associates - Related Field

Bachelor's - Business (preferred)

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 Driver Reference 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)

At Altru, everything we do is underscored by a why—and that why is one another. We believe in the power of community and the difference we can make together. As the trusted healthcare provider in our region, we’re driven by a commitment to quality care and creating a supportive environment where every team member can thrive. Here, you’ll have opportunities to advance your skills, work with the latest technologies, and experience the fulfillment that comes from giving back—taking your career wherever you want it to go. Join our team and be part of a small community with a big heart.

Altru provides reasonable accommodations to individuals with disabilities to increase opportunities and eliminate barriers to employment. If you need a reasonable accommodation in the application process to access job postings, to apply for a job, for a job interview, for pre‑employment testing, or with the onboarding process, please contact Altru’s Human Resources Department at [e-mail] or 701.780.5107.

Altru is an Equal Opportunity Employer. Learn more or to request a copy of our Equal Employment Opportunity and Eligibility policy and Aff at no charge, please contact Altru’s Human Resources Department at [e-mail] or 701.780.5107.

Altru participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee’s Form I-9 to confirm work authorization.