Payor Contracting Analyst

The CORE Institute | HOPCo; Phoenix (AZ); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

401k with company match

HDHP with company match

Employee Assistance Program 24/7

Employee Appreciation Days

Wellness Events

Job summary

The CORE Institute | HOPCo in Phoenix, AZ seeks an experienced healthcare analytics professional to join our data-driven team. You will analyze physician reimbursement data, CMS regulations, and cost trends to support value-based care initiatives, provider contracting, and financial planning.

Strong Excel skills, database experience, and the ability to work independently or with a team are essential.

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, VLOOKUP, 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 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.
• Possesses strong organizational skills and careful attention to detail.
• Must be able to problem-solve and come forward with recommendations.

Skills

Data analysis

Report design

Attention to detail

Education

Bachelor’s Degree preferred

Tools

Excel advanced

Relational databases

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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