Contract and Data Analyst (Managed Care)

Description

Job Summary:

Responsible for analysis of contracts and performing contract negotiations. This includes monitoring and reviewing existing contracts to ensure payment compliance, communicating and resolving contract issues both internal and external to the organization, and contributing to health system and individual contract negotiation strategies. Develops and builds contract projections models (EPIC) essential to negotiation outcomes for the health system.

Job Responsibilities:

• Analyze contracts and communicate operational impact to appropriate health system contacts.
• Develop models, analysis, and monitor financial performance of existing and proposed contracts.
• Monitor contract performance and compliance to ensure contracts are performing at expected levels by auditing financials and negotiating with payors for money due if appropriate.
• Review and negotiate language in the contracting negotiation processes.
• Develop, produce, and maintain data sets required for contract analysis.
• Develop and maintain departmental processes to manage contracts.
• Resolve contractual disputes with payors by collaborating with various health system entities and all related parties.
• Responsible for the analysis, development, and testing of contract projection models within Epic essential to negotiation outcomes for the system for both physician and hospital contracts/reimbursement.
• Build programming and perform ongoing analysis, which maintains the integrity of financial expectations of managed care contracts within the Epic system.
• Resolve programming issues related to rate and revenue codes operations through modification to yield maximum revenue potential for both physician and hospital contracts/reimbursement.
• Ensure through Epic testing that the build is developed and performing in collaboration with the Epic team to put into production and to enhance contract modeling within Epic.
• Perform other related duties as assigned to fulfill department responsibilities.

Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.

Working Relationships:

• Coordinate activities of others (does not supervise).
• Work with internal customers via telephone or face-to-face interaction.
• Work with external customers via telephone or face-to-face interaction.
• Work with other healthcare professionals and staff.
• Frequently work with individuals at Director level or above.

Skills

Required Skills & Experience:

• Three (3) - four (4) years of related experience.
• Experience with health plan insurance contracting and reimbursement for providers and facilities.
• Ability to complete Epic certification and maintain certification in assigned application modules(s).
• Ability to work independently and within a team across multiple disciplines.
• Ability to establish and meet work schedules within limited time frames and under tight deadlines.
• Analytical ability to solve both business and technical problems.
• Working knowledge of Microsoft Excel, Word, Power BI, and Access.
• Excellent interpersonal, written, and oral communication skills.
• Ability to be detail-oriented as required in the analysis and examination of complex information.

Preferred Skills & Experience:

• Experience with Microsoft Access, data warehouse applications, contract negotiations, contract financial modeling, contract language interpretation, and EPIC.

Education

Required Education:

• Bachelor's degree in business or related field.

Required Certifications & Licensure:

• Obtain and maintain Epic certification in assigned application modules(s).