Contract ManagementCDM Analyst Full Time

Job Summary :

Job Description

Essential Responsibilities:

Perform a wide range of high-level and detailed analytical functions for contract management and negotiation including but not limited to financial performance reimbursement comparisons risk analyses and quality program assessments.

Create and communicate complex financial and risk models for the purpose of evaluating historical and future performance of existing contracts

Develop and produce financial reports on a periodic and ad hoc basis for hospital management

Assist in negotiating contracts maintaining contract management software analyzing financial impact and monitoring payments for compliance

Support the managed care divisions initiatives through analysis and perform forecasts on the impact of reimbursement terms during contract negotiation process

Assist in the preparation processing research and analysis of Medicare Medicaid Commercial and Managed care cost reports to ensure the accuracy of claim payments

Review of all contracts to determine appropriate application of rates provisions and terms

Interact with various hospital stakeholders department heads and physicians to educate staff related to managed care reimbursement models

Work with departments to develop and maintain specific payment arrangements for unique services

Collaborate with CFO and Revenue Cycle Director to develop contract language

Identify potential underpayment trends through comparison of managed care contracts to actual reimbursement information via contract management technology

Investigate third-party payer policies and contracts to verify accuracy of underpayment variances according to published payer guidelines

Provide documentation for third-party payer audits

Provide reimbursement information and analysis to other hospital departments and maintain knowledge of reimbursement regulations

Adding updating or deleting charge codes prices and descriptions within the hospital billing system

Reviewing the CDM to ensure it adheres to Medicare Medicaid and other industry billing and coding guidelines

Maintains the chargemaster by incorporating new charges/services identified by departments third-party changes special requirements and coding updates

Conducts annual reviews of the chargemaster to identify codes that have been deleted added or replaced and ensures required updates to code descriptions

Ensures organization wide compliance to federal state and local regulations as well as governmental and commercial payer guidelines related to charge codes and chargemaster

Audits chargemaster changes maintains a detailed trail of these changes and communicates any change to all applicable departments

Participates in third-party charge audits with other dedicated teams and assists in inquiries related to chargemaster

Investigates CPT codes revenue codes and other issues and resolves disputes within a stipulated time frame

Supports clinical units in charge capture coding accuracy and revenue management

Performs related duties such as cost accounting cost management volume analysis functions and special projects as necessary

Knowledge Skills Abilities:

Work requires analytical skills to collect information from diverse sources apply professional principles in performing various analyses and summarize information and data in order to solve problems

Broad understanding of computer system concepts and database relationships

Good working knowledge of data management software applications with ability to create reports from data available in various systems to satisfy the needs of senior management

Ability to assess situations from a global perspectivedetermining the impact to the institution department and individuals involvedand implement changes

Thorough knowledge and understanding of hospital financial operations including the revenue cycle/reimbursement process

Proficiency with Microsoft Excel

Experience interpreting and displaying data for diverse audiences

Ability to work effectively in a team environment

Strong investigative analytical organizational and critical thinking skills

Excellent written and verbal communication skills

Ability to prioritize multiple demands and work independently with minimal supervision

Demonstrated knowledge of coding systems including ICD CPT and HCPCS codes

Knowledge of industry pricing standards and third-party reimbursement policies

Ability to stay apprised of healthcare regulatory and compliance requirements particularly in regard to Medicare Medicaid and commercial payors

Education and Experience Required:

EPIC Contract Certification in Hospital billing is required

Bachelors degree in business administration accounting statistics finance or closely related field desired

Minimum of five years of data or financial analytical experience required

Experience working with cross-functional departments to research and resolve issues using innovative solutions preferred

Work Shift :

Scheduled Weekly Hours :