Payor Contracting Analyst

The CORE Institute; Phoenix (AZ); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

HSA with qualifying HDHP plans with 4%

401k plan after 6 months of service w/

Employee Assistance Program 24/7

Job summary

The CORE Institute in Phoenix is seeking a Healthcare Financial Analyst to apply advanced data analysis to physician reimbursement and CMS methodologies. You will analyze provider billing practices and cost trends to support value-based care initiatives and improve financial performance.

Qualified candidates bring 3+ years in healthcare analytics, strong Excel and database skills, and the ability to work independently while collaborating with cross-functional teams.

Qualifications

• Minimum of three years of experience in an analytic role in a healthcare environment with knowledge of physician reimbursement methodologies.
• Intermediate to advanced MS Excel skills (pivot tables, VLOOKUPs, conditional formulas).
• Experience using relational databases.
• Bachelor’s Degree in Finance or Healthcare Administration preferred.

Responsibilities

• Demonstrate thorough knowledge of CMS regulations and reimbursement methodologies related to professional claims.
• Familiarity with value-based care payment models and industry trends.
• Familiarity with managed care products and services, medical cost trend analysis including physician contracts, utilization, and costs.
• Possesses strong organizational skills and attention to detail.
• Ability to problem-solve and make recommendations.
• Ability to work independently and as part of a team.

Skills

Analytical thinking

Excel skills

Data analysis

Attention to detail

Problem solving

Independent and team work

Education

Bachelor’s degree in Finance or Healthcare Administration preferred

Tools

Relational databases

CMS regulations knowledge

Job description

• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

Minimum Qualifications:

• Minimum of three years of experience working in an analytic role in a healthcare environment (payor or provider) with an in-depth knowledge of physician reimbursement methodologies.
• Intermediate to advanced-level MS Excel skills (pivot tables, vlookups, conditional formulas).
• Experience using relational databases.
• Bachelor’s Degree in Finance or Healthcare Administration preferred.

Essential Functions

• Demonstrate thorough knowledge of CMS regulations and reimbursement methodologies relevant to professional claims.
• Familiarity with value-based care payment models and industry trends.
• Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs.
• Familiar with a variety of concepts, practices, and procedures in the field of managed care and practice management.
• Possesses strong organizational skills and careful attention to detail.
• Must be able to problem-solve and come forward with recommendations.
• Must be able to stay on task with minimal supervision.
• Excellent critical thinking, troubleshooting, and analytical skills.

KNOWLEDGE

• Knowledge of physician reimbursement.
• Knowledge of provider billing practices.
• Knowledge of CPT codes, modifier rules, CMS payment policies.

SKILLS

• Skill in effective data collection and analysis.
• Skill in designing analyses and appropriate reports.
• High-level attention to detail, accuracy, and organization skills.

ABILITIES

• Strong ability to prepared and understand functional and technical specifications.
• Ability to analyze problems and interpret information and prioritize and reprioritize, as necessary.
• Ability to work independently, and as part of a team.
• Ability to multi-task, manages multiple projects, and meets tight deadlines.

Equal Opportunity Employer
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