The Senior Contract Analyst, CDM will support Prime Healthcare’s Contract Analytics and Revenue Integrity functions. The Senior Contract Analyst, CDM will also collaborate with other stakeholders and process owners to ensure that the contract analytics are scaled to support other operations such as Patient Access, CDM, RIT, HIM, Coding, PFS and Denial Management. The Senior Contract Analyst, CDM will set up and maintain the contract matrix and rate levels for all hospitals, support the implementation & maintenance of the Contract Management Tool, oversee the implementation & maintenance of the internal expected reimbursement tool and collaborate with the patient access department to optimize the front-end collections workflow. The Senior Contract Analyst, CDM will ensure compliance with CMS Price Transparency Rule of posting hospital’s contracted reimbursement rates.
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EDUCATION, EXPERIENCE, TRAINING
1. Bachelor’s degree in Healthcare Administration, Finance, or a related field of study is required
2. Minimum five (5) years of experience in healthcare contract analytics or related revenue cycle operations is preferred
3. Minimum two (2) years of experience in leading US Healthcare Contract Analytics Billing, Charging or Other Revenue Cycle Functions is required
4. Experience working with the Contract Management/Analytics Tool is preferred
5. Prior experience in adjudicating the claim is required
6. Experience working with payers including Medicare, Medicaid, and commercial insurance
7. Understanding of CPT’s, HCPCs, Diagnosis code, DRG code, EAPG, revenue code, etc. is required
8. Understanding of payor payment methods viz.. Fee Schedule, RCC, Case rate is required
9. Prior experience working with EPIC and Meditech preferred
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf
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