Senior Pay/Provider Contract Analyst

This is a fully remote position, open to applicants in New York.

📋 Description

• Perform specialized and intricate analyses related to payer issues impacting the URMFG revenue cycle process.

• Detect trends, investigate problems, and propose recommendations to enhance revenue.

• Examine payer policies, including administrative and clinical edit programs.

• Develop communications for management, departments, and physicians.

• Represent URMFG with payers and address complex revenue and payer-related issues.

• Research and resolve matters related to prior authorizations, denial management, and payer policy decisions.

• Interpret reports that monitor negotiated rate variances and recoveries.

• Organize meetings with payers, UBO, senior administrators, and providers.

• Create, compile, and disseminate payer issue reports to both internal and external stakeholders.

• Monitor financial recoveries and provide guidance to Revenue Cycle Advisors and UBO staff concerning payer reimbursement.

• Identify and propose enhancements to boost operational efficiency and revenue.

• Document projects utilizing Issue Trak.

• Maintain in-depth knowledge of commercial and governmental payer reimbursement, rules, regulations, coding, and contract terms.

• Collaborate with the Associate Director on payer and financial matters.

• Coordinate with Compliance Analysts, the Office of Counsel, and Medical Staff Office managers regarding credentialing and payer provider file issues.

• Contribute insights on systems and technology implementation, including EPIC.

• Mentor, train, and support Payer Provider Contract Analyst II team members.

• Manage special reimbursement and finance projects while establishing project timelines.

• Assist in the development of payer relations policies and procedures.

• Report directly to the Associate Director of Payer Relations.

⛳️ Requirements

• A Bachelor’s degree with 5 years of experience in medical practice billing/coding/terminology or related experience is required.

• An equivalent combination of education and experience will be considered.

• Strong organizational and problem-solving skills are highly preferred.

• Exceptional customer service and communication skills (both oral and written) are strongly preferred.

• Ability to collaborate effectively with all levels of management and staff is strongly preferred.

• Proficiency in Microsoft Office applications, particularly Excel, is strongly preferred.

• Familiarity with EPIC and knowledge of Tableau reporting is preferred.

• A demonstrated understanding of CMS and AMA CPT is preferred.

🏝️ Benefits

• Full-time regular employment.

• Day shift schedule.

• 40 scheduled hours per week.