Sr Pay/Provid Contract Analyst

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

135 Corporate Woods, Rochester, New York, United States of America, 14623

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

900023 URMC Payer Contracting & Reimb

Work Shift:

UR - Day (United States of America)

Range:

UR URG 110

Compensation Range:

$61,000.00 - $85,400.00

Responsibilities:

With significant latitude for independent judgment and initiative, the Sr. Payer Provider Contract Analyst conducts specialized and complex analyses of payer issues impact on the University of Rochester Medical Faculty Group (URMFG) revenue cycle process. The Sr. Payer Provider Contract Analyst identifies trends, investigates and makes recommendations to improve revenue. Analyzes payer policies, including interpretation of administrative and clinical edit programs. Creates communications to management, departments, and physicians. Represents URMFG with payers. Has comprehensive knowledge of payer reimbursement methodologies, rules, regulations, and contract terms. The Sr. Payer Provider Contract Analyst is responsible for activities related to URMC’s largest payers and URMFG’s larger and/or more complex departments. Reports to the Associate Director, Payer Relations.

ESSENTIAL FUNCTIONS
With significant latitude for independent judgment and initiative:

• Independently researches and resolves payer issues including prior authorizations, denials management and payer policy determinations. Is integral to significant revenue recovery which contributes to enterprise financial success. Interpret reports for monitoring negotiated rate variances and recoveries. Facilitate meetings with payers, United Business Office (UBO), senior administrators and providers to resolve complex revenue/payer issues.  Represents URMFG to external payer representatives, managers, Medical Directors and Compliance.  Uses expert knowledge to influence payer outcomes beneficial to URMFG. Works in conjunction with URMC Payer Contracting & Reimbursement managers in a team approach to payer issues.
• Develops, compiles, and communicates reports that monitor payer issues to internal and external stakeholders. Tracks financial recoveries to completion and conveys processes and results to peer Revenue Cycle Advisors (RCA). Provides advice to RCAs & UBO staff regarding payer reimbursement. Identifies and presents innovative improvements to increase operational efficiencies and revenue. Ensures projects are appropriately documented using Issue Trak application. Maintains expert knowledge of commercial & government payer reimbursement, rules, regulations, coding, contract terms and conditions. Understands payer product differentiation and benefit limitations.  Keeps abreast of trends related to reimbursement requirements and financial management.
• Provides consultation to Associate Director regarding payer/financial developments for planning, control and analytical processes. Works with Compliance Analysts, Office of Counsel, and Medical Staff Office managers regarding credentialing and payer provider file issues. Provides input in the development and implementation of systems and/or new technologies, e.g. EPIC. 
• Mentors, trains & assists Payer Provider Contract Analyst II staff with ad hoc projects/report design. Responsible for special projects involving reimbursement and finance.  Establishes and adheres to project timelines and activity plans.  Assists in developing payer relations policy/procedure.  Other duties may be assigned.

MINIMUM EDUCATION & EXPERIENCE

• Bachelor's degree and 5 years of experience with medical practice billing/coding/terminology or relevant experience required
• Or equivalent combination of education and experience
  

KNOWLEDGE, SKILLS AND ABILITIES

• Excellent organizational and problem-solving skills strongly preferred
• Excellent customer service & communication skills (both oral and written) strongly preferred
• Ability to work in a team with all levels of management and staff strongly preferred
• Experience with Microsoft Office products, with emphasis on Excel strongly preferred
• EPIC fluency and Tableau reporting knowledge preferred
• Demonstrated understanding of CMS and AMA CPT preferred

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.