Payor Contracting Analyst

Summary

Healthcare Outcomes Performance Co. (HOPCo) is seeking a Payor Contracting Analyst to support healthcare analytics and reimbursement activities. The role analyzes physician contracts, utilization, costs, payment methodologies, and managed care trends while developing reports and recommendations.

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
• 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 of physician reimbursement
• Knowledge of provider billing practices
• Knowledge of CPT codes, modifier rules, CMS payment policies
• Skill in effective data collection and analysis
• Skill in designing analyses and appropriate reports
• High-level attention to detail, accuracy, and organization skills
• 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

Skills

• 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
• 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 of physician reimbursement
• Knowledge of provider billing practices
• Knowledge of CPT codes, modifier rules, CMS payment policies
• Skill in effective data collection and analysis
• Skill in designing analyses and appropriate reports
• High-level attention to detail, accuracy, and organization skills
• 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
• Bachelor's Degree in Finance or Healthcare Administration

Qualifications

Must Haves

• 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
• 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 of physician reimbursement
• Knowledge of provider billing practices
• Knowledge of CPT codes, modifier rules, CMS payment policies
• Skill in effective data collection and analysis
• Skill in designing analyses and appropriate reports
• High-level attention to detail, accuracy, and organization skills
• 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

Nice to Haves

• Bachelor's Degree in Finance or Healthcare Administration

Benefits

• Remote position
• Competitive Health & Welfare Benefits
• 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