Contract Payer Analyst

Denver Health and Hospital Authority • Denver, CO

2d

About The Position

We are recruiting for a motivated Contract Payer Analyst to join our team! We are here for life’s journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Payer Contracting Job Summary Under the general supervision of the Contract Payer Manager, the Payer Contract Analyst is responsible for overseeing and managing all Payer contracts on behalf of Denver Health & Hospital Authority. The Payer Contract Analyst reviews and manages all payer contract terms for both internal and external stakeholders. This position works closely with the Contract Payer Manager to ensure processes are in place and contractual measures are met. The Payer Contract Analyst collaborates with internal and external stakeholders to understand payer specific data, contractual requirements and operational issues.

Requirements

• Bachelor's Degree Business Administration, Health Care Administration, or related health care field. Required
• 4-6 years Minimum five or more years of recent healthcare, insurance or practice management experience. Required
• 1-3 years Minimum three years of contract management experience. Required
• Strong knowledge of Managed Care contracts is required.
• Advanced understanding of CPT, HCPCS, ICD-10 and various reimbursement methodologies such as Medicare/ Medicaid and third party billing requirements.
• Extensive knowledge and experience with Medicare/ Medicaid regulations.
• Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills.
• Strong working knowledge of billing and collection processes and functions, general revenue cycle management strategies and industry best practices.
• Detail Oriented and have a strong ability to multi-task with ability to exercise judgment in differing situations.
• Utilizes software applications and working knowledge of the following information systems to include accessing information, updating, correcting and/ or deleting data.
• General knowledge related to various software applications and their capabilities.
• Microsoft Office applications: Word, Excel, Access, PowerPoint and Outlook and other applications as needed.
• Ability to be resourceful, customer-service oriented and independently problem-solve is required.
• Ability to independently define problems and develop relative solutions, collect data, establish facts, and draw valid conclusions.
• Proficient in Microsoft Word and Excel with excellent computer skills.

Responsibilities

• Develops and maintains contract management resources and tools.
• Builds and manages the contract management software system for the department.
• Accurately enters contract-related data into contract management system to maintain and manage contract records and monitor contract compliance.
• Ensures all resources are updated with the new contract information and the new information is communicated to all appropriate staff prior to contract effective date.
• Interprets third party payer contract language and understands contract details and the major provisions of agreements as they relate to day to day operations (e.g. timely filing limits, refunds, rate schedules, term notices, facility credentialing requirements, etc.).
• Develops strong relationships with internal and external customers and serves as an escalation point between third party payers and internal departments such as Revenue Cycle, Registration, Patient Access and Medical Staff Office to resolve issues related to contracting, billing, payments, registration and provider roster issues.
• Negotiates single case agreements to capture financial reimbursement from non-contracted entities.
• Assists in specific contract negotiations, financial modeling and contract follow up for special projects.
• Ensures the department possesses relevant knowledge of Payer Enrollment requirements of various third party payers, Medicare and Medicaid, and maintains the delegated payer credentialing status.
• Collaborates with Medical Staff Office to collect and submit accurate information for the provider directories; updates, audits and sends provider rosters to commercial payers in compliance with NCQA standards.
• Oversees, updates and maintains provider credentialing databases, such as CAQH.
• Maintains Denver Health facility and clinic credentialing with third party payers..
• Promotes professional growth and development through leadership activities and continuing education and training.
• Maintains involvement in local/regional/national professional organizations.
• Maintains current knowledge of payer and market industry changes and trends and communicates results to the department and other staff.

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
• Free RTD EcoPass (public transportation)
• On-site employee fitness center and wellness classes
• Childcare discount programs & exclusive perks on large brands, travel, and more
• Tuition reimbursement & assistance
• Education & development opportunities including career pathways and coaching
• Professional clinical advancement program & shared governance
• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees