Payor Relations And Contracts Analyst

General Summary

Strong Epic experience is preferred for this position.

Under limited supervision to support UMMS enterprise-wide, unregulated, clinical service contracting, develops, analyzes, reports and interprets financial billing and statistics and contracting information. Assists with the formation, implementation and execution of the organization's business plans regarding Managed Care and Third Party Payor contracting for the University of Maryland Medical System. Analyzes contract proposals to assess financial viability, creates financial models for review and provides recommendations to UMMS leadership.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. 1. Reviews third party payor contracts to develop financial models to determine financial viability of such arrangements.
2. 1. Prepares financial and statistical reports for Third Party Payor contracts and assists analytics manager in the development of business plans for all Third Party Payor contracts.
3. 1. Performs fee schedule analysis and reimbursement modeling related to payor contracting opportunities. Analyzes performance of third party payor contracts using relevant market, financial, statistical and utilization data to ascertain trends and to isolate deviations from established plans. Discusses results to maximize favorable contract performance and minimize unfavorable performance.
4. 1. Supports analytics manager in maintaining contracting database to include UMMS system-wide entities for unregulated contracting and contracted payors.
5. 1. Provides assistance in the development of long-term financial forecasts that incorporates the changes in patient service activity, the reimbursement environment, payor mix, operating costs, capital financing structure and overall capital requirements.
6. 1. Provides assistance with development, implementation and monitoring of new reports and procedures that will improve UMMS billing/collection and reimbursement processes.
7. 1. 1. Supports Payer Relations & Contracting department EPIC payment compliance and patient estimator processes, to include backup for loading of payer contracts into EPIC, ongoing reimbursement and coding updates, and testing and trouble-shooting.
8. 1. 1. Resolves issues identified by Claims/Billing/Collection Specialists in accordance with departmental procedures.
9. 1. 1. Monitors and verifies transactions to confirm compliance and to ensure accurate financial reporting and contract/payment compliance.
10. 1. Works collaboratively and communicates regularly with Payer Relations & Contracting team and UMMS business offices for clinical entities. Provides analytical and technical support on volume and revenue analysis, budgeting, financial planning analysis, and regulatory policies and procedures.
11. 1. Serves as a resource to the Payor Relations and Contracting department and other UMMS departments, senior management and physicians. Provides guidance and input to staff and physicians as required on reading reports and interpreting financial data