Payor Contract Analyst, Intermediate

UPMC; Pittsburgh, Northern (Allegheny County, KY); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Hybrid work environment

Job summary

UPMC is seeking a Payor Contract Analyst, Intermediate to join our team in a hybrid work environment. The role focuses on developing, negotiating, implementing and maintaining managed care and payor agreements with internal stakeholders.

The successful candidate will analyze contract terms, reimbursement and the financial impact of negotiations, and contribute to revenue optimization across hospital sites. This full-time position offers collaboration across departments and data-driven decision

Qualifications

• Knowledge of payor contracting and managed care agreements.
• Ability to analyze contract terms and reimbursement impact.
• Experience supporting negotiation and financial modeling for contracts.

Responsibilities

• Prepare advanced reimbursement models including payor rates and fee schedules for proposed terms.
• Data mine provider and payor financial data for analysis.
• Test payor claims to ensure accuracy against contract terms.
• Maintain Payor Detail Matrix and Contracted Insurance Matrix for hospitals.
• Research internal payor questions related to contracts and policies.
• Research insurance company policies and rates to support revenue modeling.
• Verify payor rate schedule updates for term compliance.
• Collaborate within the department to maximize outcomes.
• Prepare financial and operational reports to support contractual decisions.

Skills

Payor contracting knowledge

Contract negotiation

Data analysis

Tools

Excel

SQL

Job description

We're searching for a Payor Contract Analyst, Intermediate to join the team! If you're a self-motivated individual with knowledge of payor contracting, this could be the perfect fit for you!

The Payor Contract Analyst, Intermediate supports the development, negotiation, implementation and maintenance of managed care and payor agreements as well as relationships with various payors and internal stakeholders. They'll analyze contract terms, reimbursement and the financial impact of negotiations.

This full-time position offers a hybrid work environment. Apply online today for your chance to join the team!

Responsibilities:

• Prepare advanced reimbursement models, including but not limited to, case and per diem rates, cost and day outliers, and advanced fee-for-service fee schedules for the purpose of determining payor contract proposed terms as compared to current contractual terms and other comparable payor contract terms.
• Data mine provider and payor financial and operational data population for analysis. Define the necessary data elements required for the project.
• Perform testing on advanced payor claims to ensure accuracy and compliance to contract terms.
• Maintains Top Ten Payor Detail Matrix and Contracted Insurance Matrix for all hospitals.
• Researches and responds to moderately complex internal UPMC entities and payor questions as they relate to contracts.
• Coordinate the process of research on insurance companies and other payors medical policies, billing policies, contracted reimbursement rates and related issues to assist in evaluating and modeling payor financial performance in order to maintain or develop new or enhanced revenue streams.
• Verification of payor rate schedule updates for compliance to contract terms.
• Interact as a team member of the department to achieve maximum outcomes.
• Prepares financial and operational activity reports to support contractual decisions including assumptions and observations.