Contract and Reimbursement Analyst

Job Description

The Contract and Reimbursement Analyst will provide financial and analytical support for managed care contract negotiations and reimbursement monitoring across all payers for - UT Health San Antonio ”. This role requires a deep understanding of physician and facility reimbursement methodologies, the ability to analyze and synthesize large data sets, and a commitment to maintaining the highest level of data integrity. This position will report directly to the Director of Managed Care. The analyst is expected to collaborate internally within UTHSA across various departments (e.g., finance, IT, revenue cycle, coding) as well as externally with managed care organizations.

Responsibilities

• Load and maintain all available payer reimbursement schedules within Epic’s Hospital Base and Physician Base Contract Management module.
• Review, understand, and interpret new and existing managed care relationships/contracts, including: value based, shared savings and incentive programs, for negotiation, renegotiation, and termination (when appropriate).
• Quantify the impact of managed care contract proposals in Epic and provide thoughtful analysis to the leadership and other stakeholders.
• Review and modify adjustments to existing pricing models in Epic to increase the accuracy of projected reimbursement.
• Develop and analyze reports summarizing managed care payer performance and trends. Recommend adjustments to payer payment methodologies, contracted rates, or claim processing standards to improve the financial performance of MSRH.
• Identify trends in underpayments by modeling expected reimbursement to actual reimbursement and work collaboratively with payers and other internal stakeholders, as required.
• Work collaboratively with members of the revenue cycle and IT teams to support reimbursement variance monitoring tools in Epic, CDM updates, pre-visit patient financial estimates, mass payer appeals, general payer relations concerns, or other needs as identified.
• Maintain relationships and professionally collaborate with managed care payer representatives to improve managed care collections and positively resolve contract interpretation issues.
• Communicate contract issues and relevant updates to payer payment and/or claims processing methodologies to revenue cycle stakeholders.
• Work with finance staff to develop projections for the annual budget process.
• Assist with establishing, tracking, and maintaining letters of agreement (LOA), and single case agreements (SCA) with commercial, Medicaid, and Medicare health plans.
• Communicate managed care updates and content within the department and organization through internal systems, including but not limited to: SharePoint, website information, and newsletters.

Qualifications

• Extensive knowledge of claims process, medical terminology and healthcare concepts, including knowledge of CPT/HCPCS, ICD-10, DRG coding and methodologies.
• Fundamental knowledge of managed care payment models as well as inpatient and outpatient reimbursement methodologies, such as MS-DRG, AP-DRG, per diems, case rates, RBRV’s and percentage discounts.
• Specific experience with commercial health plans, Texas Medicaid and Medicare reimbursement.
• Direct experience with management and maintenance of contract modeling platforms (preferably in Epic).
• Strong understanding of financial and accounting principles.
• Proficiency in word processing, spreadsheet, and database software.
• Ability to analyze complex problems, draw relevant conclusions, and implement comprehensive solutions.
• Excellent analytical and financial skills with an eye for detail and accuracy.
• Exceptional communication and interpersonal skills, with the ability to collaborate professionally outside the organization.

Experience

• Five (5) years of related experience with reimbursement modeling and contract management

Education

• Bachelors Degree in mathematics, statistics, business, finance, health care administration, or related field required. A combination of relevant education and experience may be considered.
• Resolute Hospital Billing Reimbursement Contracts Administration Certification Required 180 after start date

Required Skills Five (5) years of related experience with reimbursement modeling and contract management. Apply tot his job Apply To this Job