The CORE Institute
Posted 2 days agoVerified live 6h ago
Payor Contracting Analyst
Brief overview
Remote
UndergradOr in progress
3+ yrsMinimum
MS ExcelHealthcare AnalyticsPhysician Reimbursement MethodologiesCMS Regulations and Payment PoliciesCPT Coding and Modifier RulesProvider Billing PracticesValue-Based Care Payment ModelsManaged CareMedical Cost Trend AnalysisPhysician Contract AnalysisUtilization and Cost AnalysisData Analysis
About the company
The CORE Institutethecoreinstitute.com
The CORE Institute, a leading provider of healthcare solutions, care redesign, and service line management.
Job description
Summary
The CORE Institute is seeking a Payor Contracting Analyst to support healthcare reimbursement and managed care analytics. The role analyzes physician contracts, utilization, costs, payment methodologies, and industry trends while developing reports, solving problems, and providing 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
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
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