Senior Payor Contracting and Financial Analyst

Proliance Surgeons
13 Jan 2019
02 Feb 2019
Contract type
Full time
The Central Business Office of Proliance Surgeons Inc., is looking for a Senior Payor Contracting and Financial Analyst to join our team.


Essential Functions:
  • Provide analytics to support payor contracting and be responsible for all financial analysis including contract negotiations
  • Develop tools and reporting to monitor reimbursement trends, and identify opportunities for improvement
  • Assist in fee schedule maintenance and contract interpretation disputes ?
  • Responsible for analysis to support payment bundling initiatives

This position reports to the Director of Analytics and Payor Contracting.

Job Responsibilities:
  • Conducts payor contract proposal impact analysis and modeling: assesses reimbursement trends, identifies risks, develops projections, and provides recommendations on counter proposals
  • Using Excel, SQL, Access, or other data analysis tools, develops analyses to support decision making
  • Responsible for organizational wide reporting of reimbursement trends
  • Performs ad–hoc analysis and reporting packages on cost of care, collaborates with care centers and executives in the process
  • Leads financial assessment of special projects
  • Acts as liaison between corporate and care centers for reimbursement and payer contracting issues
  • Maintains a working knowledge of applicable Federal and State reimbursement laws and regulations?as well as payor payment policies and procedures
  • Identifies changes in regulations and payor policies on a timely basis, identifies the contracts impacted and related financial impact. ? Communicates changes to care centers
  • Compiles and maintains charge master, billing codes, and fee schedules
  • Reviews claim payments to ensure contract implementations are correct, monitors? compliance with contractual terms
  • Supports Contacting Committee with ad–hoc financial requests
  • Assists in developing and implementing financial case costing methodologies
  • Assists in financial assessment and financial monitoring of bundling initiatives
  • Assists in developing operational flow of bundling initiatives as relates to billing, payments, and invoicing
  • Mentors and trains other analysts
  • Attends and participates in internal and client meetings as needed
  • Engages in process and quality improvement activities to minimize manual efforts
  • Performs other duties as required by management

  • Bachelor?s degree or greater in Finance, Accounting, Business Administration, Healthcare Management, or related field
  • MBA/MHA preferred
  • Minimum of 5 years? experience working in the healthcare industry. ?
  • Payor contracting/ healthcare analytics background preferred ? ?
Skills/Professional and Personal Qualities
  • Knowledge of coding conventions i.e. (Revenue Codes, Occurrence Codes, ICD–9, ICD–10, CPT and HCPCS codes)
  • Knowledge of the various types of health insurance payers: Medicare, Medicare Advantage Plans, Commercial, Medicaid, and Medicaid Managed Care
  • Broad ranging knowledge of ASC?s, Clinics, and Ancillary Services
  • Knowledge of healthcare reimbursement methodologies, contract language, and public healthcare programs
  • Strong analytical skills and familiarity with common data analytics tools including Excel, Access, SQL, or other analytics tools. ? Experience with Business Intelligence tools would be a plus
  • Ability to communicate effectively using data with all levels of the organization
  • Self–motivated team player able to multi–task and prioritize
  • Comfortable with ambiguity and able to quickly adapt to changing priorities
  • Ability to lead projects and initiatives
How To Apply:

If interested in?applying, please submit your cover letter and resume through the form below or?email to [Click Here to Email Your Resum?] .
  • Use ? Senior Payor Contracting and Financial Analyst ? as the subject.
  • Applicants under consideration will be scheduled for a Skype or FaceTime interview. Successful first round candidates will be invited to interview in person.
We regret we are not in position to personally respond to all applicants.