Payor Contract Analyst, Associate
UPMC - Pittsburgh, PA

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UPMC Corporate Services is hiring a full-time Payor Contract Analyst Associate to help support the Payor Contract Services Department for its UPMC Corporate Services South Side location (Quantam Building). The hours of this position will be Monday through Friday, standard daylight hours. The Payor Contract Associate will validate, distribute and file the payor rate updates, maintain the Executive Rate Matrix, maintain the contract files and perform limited administrative support. This position will support all managers and analysts within the department as needed.

Responsibilities

- Prepares basic per diem reimbursement contract models to support the department's analysis of sub-provider contracts for rehabilitation units, behavioral health units and skilled nursing units; other per diem based payors; and basic fee-for-service fee schedules for the purpose of determining payor contract proposed terms as compared to current contractual terms and other comparable payor contract terms.
- Performs testing on basic payor claims to ensure accuracy and compliance to contract terms.
- Assists in compiling statistical, cost, financial and operational reports for payors performance.
- Researches and responds to basic internal UPMC entities questions as they relate to managed care contracts.
- Assist with the process of research on insurance companies and other payors medical policies, billing policies, contracted reimbursement rates and related issues to assist in evaluating and modeling payor financial performance in order to maintain or develop new or enhanced revenue streams.
- Assist in the verification of payor rate schedule updates for compliance to contract terms.
- Interact as a team member of the department to achieve maximum outcomes.
- Distributes contracts and rate update notification to appropriate parties and files documents.

Basic Qualifications

- Bachelor's Degree in Finance, or related business field is required.
- Basic understanding of healthcare terminology, insurance contract language and hospital/professional payment methodologies, including a basic understanding of Medicare and PA Medicaid reimbursement.
- Working knowledge of Microsoft Excel, familiarity with Crystal, Cognos, Word and Access preferred.
- Must be an effective team player.

Salary Range:

16.33

21.70

27.07

UPMC is an equal opportunity employer.

UPMC - 22 months ago - save job
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UPMC is one of the leading nonprofit health systems in the United States. A $10 billion integrated global health enterprise headquartered in...