Contract Management Analyst

The University of Chicago Medicine • Burr Ridge, IL

5d • Remote

About The Position

Join one of the nation’s most comprehensive academic medical centers, UChicago Medicine, as a Contract Management Analyst with our Finance- Managed Care team. We are committed to a patient-centric, efficient health care delivery system that focuses on quality, safety, service, and operational excellence.
REMOTE OPPORTUNITY
Job Summary
The Contract Management Analyst is responsible for building all third-party payer contract reimbursement terms (contract profiles) including but not limited to Managed Care Commercial payers, Government programs (Medicare, IL Medicaid), Medicare Advantage payers and Medicaid payers into UCM contract management systems and calculating expected reimbursement at the claim level (hospital) and line level (Physician). The Analyst will be responsible for updating and maintaining the accuracy of contract profile builds in the contract management systems and will develop variance reports that analyze expected reimbursement to actual payment to determine internal issues or payer compliance payment variances. The variance reports shall also ensure consistent expected reimbursement results across contract management systems and root cause and adjust as needed. The Analyst shall serve as a managed care subject matter expert for hospital and physician contract rate methodology and reimbursement terms and will, as needed, run analyses to understand historical trends and future performance of existing contracts. Assists OMC VP and Directors in payer contract negotiations as requested and applicable, particularly with review of potential reimbursement methodologies and their feasibility to be built in the contract management system. Assists Revenue Cycle management teams in review of payment variances and underpayment recoveries.

Requirements

• Bachelor’s degree in Business, Finance, Healthcare, or related field, or a combination of relevant education and experience
• Five or more years of experience in a multi-facility health system in either: -Finance operations like managed care (preferred), cost accounting, planning, or budget -Revenue cycle operations such as billing, collections, or payment processing
• Detailed knowledge of hospital and physician complex reimbursement methodologies, particularly fee for service commercial contracts as well as Medicare and Medicaid
• Excellent understanding of contract language and rate terms, physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws. Examples include:
• Proficient understanding of MS-DRG, APC, EAPG, case rate, stoploss, carveout reimbursement methodologies
• Proficient understanding of Revenue Code and CPT coding in a clinical/hospital/ASC/physician office setting
• Proficient manage care contract rate interpretation skills
• Requires familiarity and aptitude with contract management systems or modeling systems and/or cost accounting systems that build payer contract profiles
• Requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case for a recommended course of action.
• Excellent analytical and problem solving skills, and the ability to make decisions quickly and independently.
• Strong attention to detail and well organized.
• Adapts well to rapid change and multiple, demanding priorities with excellent time and project management skills.
• Ability to understand and interpret federal regulations and policies, coding guidelines and reimbursement changes.
• Interact effectively with colleagues in a variety of contexts and forums and contribute as a team player.
• Microsoft Office Suite advanced proficiency also required, particularly Excel. Strong aptitude for learning additional software or systems as needed, particularly finance and revenue cycle billing systems.

Nice To Haves

• Value based care (VBC) risk reimbursement structure knowledge preferred
• Experience with payer compliance review including underpayment variances and denial management highly desirable.
• Certification in Epic Resolute Expected Reimbursement Contracts Administration and NThrive Contract Management system- If you don't currently have certification, You must obtain within 6 months of employment.

Responsibilities

• Responsible for all payer contract profile builds including calculation of expected reimbursement terms in all FFS contracts and contract rate model builds for system hospitals and physicians in any contract management system.
• Leads ongoing maintenance and auditing of contract management rate calculations to check for variances to expected contract terms.
• Works with OMC and Revenue Cycle teams on variance analysis of contract profile outputs to current payments.
• Based on review of models and audits for variance, works with these parties and payers on underpay opportunities and payment issues stemming from non-compliance with contract terms.
• Create reports of contract outputs, historical trends, and variance analyses as needed for OMC, revenue cycle, and senior leadership
• Review payer contract proposal terms, in conjunction with OMC leaders, for accuracy and implementation feasibility
• Continued education on ever-changing reimbursement rules and policy updates both commercial and governmental that impact expected reimbursement and contract profiles and education of internal stakeholders on reimbursement terms, methodology and impacts as needed

Benefits

• UChicago Medicine is committed to transparency in compensation and benefits.
• The pay range provided reflects the anticipated wage or salary reasonably expected to be offered for the position.
• The pay range is based on a full-time equivalent (1.0 FTE) and is reflective of current market data, reviewed on an annual basis.
• Compensation offered at the time of hire will vary based on candidate qualifications and experience and organizational considerations, such as internal equity.
• Pay ranges for employees subject to Collective Bargaining Agreements are negotiated by the medical center and their respective union.
• Review the full complement of benefit options for eligible roles at Benefits - UChicago Medicine.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level