Healthcare Outcomes Performance Co. (HOPCo)
Payor Contracting Analyst - Managed Practices
Healthcare Outcomes Performance Co. (HOPCo), Phoenix, Arizona, United States, 85003
Payor Contracting Analyst - Managed Practices
Join to apply for the
Payor Contracting Analyst - Managed Practices
role at
Healthcare Outcomes Performance Co. (HOPCo) Payor Contracting Analyst - Managed Practices
19 hours ago Be among the first 25 applicants Join to apply for the
Payor Contracting Analyst - Managed Practices
role at
Healthcare Outcomes Performance Co. (HOPCo) Prepare analysis related to the financial performance of payor physician and facility 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 and payment validation. Provide analysis for all payor agreements to identify improvement opportunities and prioritize contract renegotiations. Evaluate current contracts to market benchmarks utilizing a variety of payor transparency data sources. 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, revenue cycle, and credentialing departments.
Essential Functions
Prepare analysis related to the financial performance of payor physician and facility 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 and payment validation. Provide analysis for all payor agreements to identify improvement opportunities and prioritize contract renegotiations. Evaluate current contracts to market benchmarks utilizing a variety of payor transparency data sources. 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, revenue cycle, and credentialing departments.
EDUCATION
Bachelor’s Degree in Finance or Healthcare Administration preferred.
Experience
Minimum of three years of experience working in an analytic role in a healthcare environment (payor or provider) with an in-depth knowledge of physician reimbursement methodologies. Intermediate to advanced-level MS Excel skills (pivot tables, vlookups, conditional formulas). Experience using relational databases.
Requirements
Demonstrate thorough knowledge of CMS regulations and reimbursement methodologies relevant to professional claims. Familiarity with value-based care payment models and industry trends. Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs. Familiar with a variety of concepts, practices, and procedures in the field 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. Excellent critical thinking, troubleshooting, and analytical skills.
KNOWLEDGE
Knowledge of physician reimbursement. Knowledge of provider billing practices. Knowledge of CPT codes, modifier rules, CMS payment policies.
Skills
Skill in effective data collection and analysis. Skill in designing analyses and appropriate reports. High-level attention to detail, accuracy, and organization skills.
Abilities
Strong ability to prepared and understand functional and technical specifications. Ability to analyze problems and interpret information and prioritize and reprioritize, as necessary. Ability to work independently, and as part of a team. Ability to multi-task, manages multiple projects, and meets tight deadlines.
ENVIRONMENTAL WORKING CONDITIONS
Normal office environment or remote work location Some travel within the community.
PHYSICAL/MENTAL DEMANDS
Requires sitting and standing associated with a normal business environment. Some bending and stretching are required. Manual dexterity using a calculator and computer keyboard.
Organizational Requirements
HOPCo Mission, Vision, and Values must be acknowledged and adhered to
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
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Join to apply for the
Payor Contracting Analyst - Managed Practices
role at
Healthcare Outcomes Performance Co. (HOPCo) Payor Contracting Analyst - Managed Practices
19 hours ago Be among the first 25 applicants Join to apply for the
Payor Contracting Analyst - Managed Practices
role at
Healthcare Outcomes Performance Co. (HOPCo) Prepare analysis related to the financial performance of payor physician and facility 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 and payment validation. Provide analysis for all payor agreements to identify improvement opportunities and prioritize contract renegotiations. Evaluate current contracts to market benchmarks utilizing a variety of payor transparency data sources. 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, revenue cycle, and credentialing departments.
Essential Functions
Prepare analysis related to the financial performance of payor physician and facility 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 and payment validation. Provide analysis for all payor agreements to identify improvement opportunities and prioritize contract renegotiations. Evaluate current contracts to market benchmarks utilizing a variety of payor transparency data sources. 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, revenue cycle, and credentialing departments.
EDUCATION
Bachelor’s Degree in Finance or Healthcare Administration preferred.
Experience
Minimum of three years of experience working in an analytic role in a healthcare environment (payor or provider) with an in-depth knowledge of physician reimbursement methodologies. Intermediate to advanced-level MS Excel skills (pivot tables, vlookups, conditional formulas). Experience using relational databases.
Requirements
Demonstrate thorough knowledge of CMS regulations and reimbursement methodologies relevant to professional claims. Familiarity with value-based care payment models and industry trends. Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs. Familiar with a variety of concepts, practices, and procedures in the field 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. Excellent critical thinking, troubleshooting, and analytical skills.
KNOWLEDGE
Knowledge of physician reimbursement. Knowledge of provider billing practices. Knowledge of CPT codes, modifier rules, CMS payment policies.
Skills
Skill in effective data collection and analysis. Skill in designing analyses and appropriate reports. High-level attention to detail, accuracy, and organization skills.
Abilities
Strong ability to prepared and understand functional and technical specifications. Ability to analyze problems and interpret information and prioritize and reprioritize, as necessary. Ability to work independently, and as part of a team. Ability to multi-task, manages multiple projects, and meets tight deadlines.
ENVIRONMENTAL WORKING CONDITIONS
Normal office environment or remote work location Some travel within the community.
PHYSICAL/MENTAL DEMANDS
Requires sitting and standing associated with a normal business environment. Some bending and stretching are required. Manual dexterity using a calculator and computer keyboard.
Organizational Requirements
HOPCo Mission, Vision, and Values must be acknowledged and adhered to
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Business Development and Sales Industries Hospitals and Health Care Referrals increase your chances of interviewing at Healthcare Outcomes Performance Co. (HOPCo) by 2x Get notified about new Analyst jobs in
Phoenix, AZ . Phoenix, AZ $60,000.00-$80,000.00 1 week ago Investigative Analyst (Criminal Analyst)
Technical Business Analyst V (Job 2839 & 2840)
Phoenix, AZ $65,000.00-$75,000.00 1 week ago Phoenix, AZ $70,000.00-$135,000.00 6 days ago Finance & Operations Analyst (Entry Level)
Scottsdale, AZ $62,000.00-$102,300.00 1 month ago Automation Process Analyst/Trainer - Specialist V (Job 2872)
Phoenix, AZ $55,000.00-$105,000.00 3 days ago Tempe, AZ $80,000.00-$110,000.00 4 weeks ago Phoenix, AZ $75,100.00-$112,700.00 3 days ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr