Senior Payer/Provider Contract Analyst
New
J
JobgetherHealthcare revenue cycle
Based in the United StatesFull-TimeSenior
Salary61,000 - 85,400 USD per year
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Job Details
- Experience
- At least 5 years of experience in medical practice billing, medical coding, medical terminology, or a related field
- Required Skills
- TableauMicrosoft Excel
Requirements
- Hold a bachelor's degree and have at least 5 years of experience in medical practice billing, medical coding, medical terminology, or a related field; an equivalent combination of education and relevant professional experience may be considered.
- Understand healthcare revenue cycle operations, medical billing processes, payer reimbursement methodologies, and provider contracting practices.
- Demonstrate the ability to independently investigate and resolve complex payer issues, reimbursement discrepancies, prior authorization challenges, and claim denials.
- Know commercial and government insurance programs, payer policies, reimbursement regulations, contractual terms, and benefit structures.
- Have familiarity with CMS guidelines and AMA Current Procedural Terminology (CPT) standards; these are preferred.
- Interpret financial data, identify reimbursement trends, evaluate payment variances, and recommend solutions.
- Prepare financial reports, monitor revenue recovery, track payer issues, and present findings to management and cross-functional stakeholders.
- Be proficient in Microsoft Office applications, particularly Excel, for financial analysis, reporting, and data management.
- Have familiarity with EPIC and Tableau reporting tools; these are preferred.
- Manage multiple projects, establish priorities, maintain attention to detail, and meet deadlines.
- Collaborate with senior management, physicians, revenue cycle professionals, and external payer representatives.
- Bring experience mentoring colleagues and sharing technical knowledge; this is an advantage.
Responsibilities
- Investigate and resolve complex payer issues, including prior authorization challenges, claim denials, reimbursement disputes, and payer policy determinations.
- Identify reimbursement discrepancies and revenue recovery opportunities to improve financial performance and revenue cycle processes.
- Analyze negotiated reimbursement rates, monitor payment variances, and interpret financial reports to identify trends.
- Facilitate discussions with insurance payers, revenue cycle teams, administrators, providers, and other stakeholders to resolve financial and operational issues.
- Develop and communicate reports on payer issues, financial recoveries, reimbursement trends, and operational performance.
- Track financial recovery initiatives through completion and communicate findings and results to relevant teams.
- Advise revenue cycle and business office staff on reimbursement policies, contract terms, benefit limitations, and payment methodologies.
- Maintain project records and issue documentation using the designated issue management application.
- Collaborate with compliance, legal, medical staff office, and credentialing teams on provider enrollment, credentialing, and payer provider file issues.
- Mentor Analyst II colleagues and contribute to payer relations and reimbursement projects, policies, and process improvements.
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