Payor Contracting Analyst

United States·Phoenixmid

OtherAnalyst

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Requirements Summary

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.

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OtherAnalyst

Requirements

~1 min read

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.

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 of physician reimbursement.
Knowledge of provider billing practices.
Knowledge of CPT codes, modifier rules, CMS payment policies.

Skill in effective data collection and analysis.
Skill in designing analyses and appropriate reports.
High-level attention to detail, accuracy, and organization skills.

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.