Senior Payor Contract Analyst - MUST live in Colorado
Senior Payor Contract Analyst - MUST live in Colorado
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$ 70300 - 109000
1 Vacancy
Job Description
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Being the heartbeat of Denver means our heart reflects something bigger than ourselves something that connects us all:
Humanity in action Triumph in hardship Transformation in health.
Department
Payer ContractingJob SummaryUnder 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. 35
- 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. 20
- Conducts financial analyst and cost comparison for payor contract negotiations. Negotiates single case agreements to capture financial reimbursement from noncontracted entities. Supports Payor Contracting Director in contract negotiations. 15
- Responsible for facility credentialing 5
- Completes other assigned special projects and research. 5
Education:
- Bachelors Degree Required or
- High School Diploma or GED and 710 years of experience in contract management provider relations or provider enrollment in lieu of bachelors degree. Required
Work Experience:
- 79 years in provider relations payor contracting provider enrollment payor configuration or providerfacility credentialing Required
Licenses:
- EPICPAEPIC 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 multitask.
- 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
RegularSalary
$70300.00 $109000.00 / yrBenefits
Outstanding benefits including up to 27 paid days off per year immediate retirement plan employer contribution up to 9.5 and generous medical plans
Free RTD EcoPass (public transportation)
Onsite employee fitness center and wellness classes
Childcare discount programs & exclusive perks on large brands travel and more
Tuition reimbursement & assistance
Education & development opportunities including career pathways and coaching
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Our Values
Respect
Belonging
Accountability
Transparency
All job applicants for safetysensitive positions must pass a preemployment drug test once a conditional offer of employment has been made.
Denver Health is an integrated highquality academic health care system considered a model for the nation that includes a Level I Trauma Center a 555bed acute care medical center Denvers 911 emergency medical response system 10 family health centers 19 schoolbased health centers Rocky Mountain Poison & Drug Safety a Public Health Institute an HMO and The Denver Health Foundation.
As Colorados primary and essential safetynet institution Denver Health is a missiondriven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community focusing on hiring and purchasing locally as applicable serving as a pillar for community needs and caring for more than 185000 individuals and 67000 children a year.
Located near downtown Denver Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
Denver Health is an equal opportunity employer (EOE). We value the unique ideas talents and contributions reflective of the needs of our community.
Applicants will be considered until the position is filled.
Required Experience:
Senior IC
Employment Type
Full-Time
