Payor Contracting Specialist - Remote

Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.

As HOPCo continues to grow, we are looking for an Payor Contracting Specialist for our Pennsylvania Market. Please see below for the functions and requirements for this position.

ESSENTIAL FUNCTIONS

• Prepare analysis related to the financial performance of payor hospital and physician contracts and contract proposals. Work in collaboration with contracting staff to develop contract proposals to improve contract financial performance.
• Extracts and queries data from multiple sources and systems and compile data in the form of written and verbal reports and presentation.
• Create queries to pull financial/claims data that will then be used to develop analytical and statistical models to help customers make informed business decisions
• Obtains updated payor fee schedules information from payors.
• Transfers fee schedule information to Revenue Cycle.
• Supports Revenue Cycle in contract and fee schedule interpretation.
• Provide analysis for all payor agreements to identify improvement opportunities and prioritize contract renegotiations.
• Evaluate current contracts to market benchmarks. Assist in the development of projected revenue improvements
• Develop management reports to monitor contract performance.
• Supports Management by providing information, locating data sources and collecting data under tight time constraints.
• Create financial models as required to analyze data and report efficiently for existing and new reports.
• Identify and analyze utilization patterns driving health care costs and recommend actions to impact financial performance
• When necessary serves as the liaison between health plans and revenue cycle.
• Create queries to pull financial/claims data that will then be used to develop analytical and statistical models to help customers make informed business decisions.

EDUCATION

• Bachelor’s Degree in Finance or Healthcare Administration required.

EXPERIENCE

• Must have a minimum of five years of experience working in analytic or analyst role in a healthcare environment with an in-depth knowledge of physician and hospital reimbursement.
• Experience in using relational databases, decision support systems, analysis and modeling.

REQUIREMENTS

• Demonstrate thorough knowledge of CMS regulations and configure analytic tools to support.
• Demonstrate thorough knowledge of CMS regulations and financing models.
• Familiarity with Accountable Care Organization industry trends.
• Familiarity with managed care products and services, medical cost trend analysis, including analysis of hospital and physician contracts, utilization and costs.
• Familiar with a variety of concepts, practices and procedures in the filed of managed care and practice management.
• Possesses strong organizational skills and careful attention to detail.
• Must be able to problem solve and come forward with recommendations.
• Must be able to stay on task with minimal supervision.
• Advance computer skills- proficient in Microsoft Outlook, Word and Excel.
• Excellent critical thinking, troubleshooting and analytical skills.

KNOWLEDGE

• Knowledge of hospital and physician reimbursement,
• Knowledge in both billing processes utilized and specific applications.
• Knowledge of DRG and CPT codes.

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