Payor Contracting Analyst

Healthcare Outcomes Performance Company

  • Phoenix, Arizona
  • 30+ days ago
  • Remote

    Highlights

    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. Familiarity with managed care products and services, medical cost trend analysis, including analysis of physician contracts, utilization, and costs.

    Numbers & Facts

    LocationPhoenix, Arizona (
    Remote
    )
    Websitehttps://hopco.com

    Description

    Remote position 

    Benefits:

    • Competitive Health & Welfare Benefits
    • HSA with qualifying HDHP plans with company match
    • 401k plan after 6 months of service with company match (Part-time employees included)
    • Employee Assistance Program that is available 24/7 to provide support
    • Employee Appreciation Days
    • Employee Wellness Events

    Minimum Qualifications:

      • 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.
      • Bachelor’s Degree in Finance or Healthcare Administration preferred.

      Essential Functions

      • 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.

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