Senior Payor Contract Analyst at Denver Health in Denver, CO

Job description

We are recruiting for a mission-driven Senior Payor Contract Analyst to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey. Our Values Respect | Belonging | Accountability | Transparency Department Payer Contracting Job Summary Under the general supervision of the Payor Contracting Director, the Senior Payor Contract Analyst is responsible for overseeing and managing commercial and Medicare Advantage payor contracts. This position serves in a provider relations and roster management capacity for both internal and external stakeholders. The Senior Payor Contract Analyst works closely with the Medical Affairs provider credentialing team, Revenue Cycle (including Hospital Physician Business Services, Coding, Patient Access, Reimbursement and other related departments), Finance department and external commercial insurance payor representatives. This position collaborates internally and externally to understand and improve provider rosters, provider data, provider configuration, claims denials, operational issues and payor contractual requirements. Essential Functions : Ensures the payor contracting department possesses relevant knowledge of commercial and Medicare Advantage payor enrollment requirements and develops and maintains provider rosters issues and a mechanism for resolving enrollment issues. (5%) Collaborates with Medical Staff Office to collect and submit accurate information for the provider directories; updates, audits and sends provider rosters to commercial payers in compliance with payor standards. (20%) Develops strong relationships with internal and external customers and serves as a liaison between payors and internal departments such as Revenue Cycle, Registration, Patient Access and Medical Staff Office to resolve issues related to provider roster issues, contracting, billing, payments and registration. (25%) Conducts financial analyst and cost comparison for payor contract negotiations. Negotiates single case agreements to capture financial reimbursement from non-contracted entities. Supports Payor Contracting Director in contract negotiations. (40%) Responsible for facility credentialing (5%) Completes other assigned special projects and research. (5%) Education : Bachelor's Degree Required or High School Diploma or GED and 4-6 years of experience in contract management, provider relations or provider enrollment in lieu of bachelor's degree. Required Work Experience : 4-6 years in provider relations, payor contracting, provider enrollment, payor configuration or provider-facility credentialing Required Licenses : EPICPA-EPIC Provider Administrator - DHHA - Denver Health and Hospital Authority Knowledge, Skills and Abilities : Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills. Strong ability to articulate complex issues to broad audience. Strong knowledge of commercial and Managed Medicare contracts is required. Understanding of provider data fields open/closed panel, taxonomy, hospital based, PCP, Specialist, provider directories as well as services line and CPT procedures. Working knowledge of billing, reimbursement and general revenue cycle management strategies. Excellent organizational skills, detail oriented and have a strong ability to multi-task. Utilizes software applications and working knowledge of the following information systems to include accessing information, updating, correcting and/ or deleting data. General knowledge related to various software applications and their capabilities. Microsoft Office applications: Word, Excel, PowerPoint and Outlook and other applications as needed. Ability to independently define problems and develop relative solutions, collect data, establish facts, and draw valid conclusions. Shift Work Type Regular Salary $76,700.00 - $115,100.00 / yr Benefits At Denver Health, we take care of the people