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University of Maryland Medical System · 2 days ago
Payor Relations And Contracts Analyst
Linthicum Heights, MD
Full-time
Onsite
Mid Level
2+ years exp
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Responsibilities
Reviews third party payor contracts to develop financial models to determine financial viability of such arrangements.
Prepares financial and statistical reports for Third Party Payor contracts and assists senior contract analyst in the development of business plans for all Third Party Payor contracts.
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.
Supports senior contract analyst in maintaining contracting database to include UMMS system-wide entities for unregulated contracting and contracted payors.
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.
Provides assistance with development, implementation and monitoring of new reports and procedures that will improve UMMS billing/collection and reimbursement processes.
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.
Resolves issues identified by Claims/Billing/Collection Specialists in accordance with departmental procedures.
Monitors and verifies transactions to confirm compliance and to ensure accurate financial reporting and contract/payment compliance.
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.
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.
Qualification
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Required
Bachelor’s degree in Finance, Accounting or a related field, or equivalent experience is required.
Two (2) years’ experience in financial and data analysis required. Healthcare finance experience is preferred.
Knowledge of Medicare and commercial payer reimbursement methodologies and CPT (Current Procedural Terminology)/HCPCS (Healthcare Common Procedure Coding System) is preferred.
Expert knowledge of spreadsheets (i.e., Microsoft Excel), word processing programs (i.e., Microsoft Word), graphic/specialty and other finance related software programs. Ability to teach others and act as a department resource of expertise.
Knowledge of payer contracts to include terminology and reimbursement methodologies.
Ability to keeps up-to-date with the developments/changes in the field and applicable regulations and procedures affecting hospital and physician finance and regulatory practices. Attends and participates in in-service training and various educational programs for professional growth and development.
Ability to judge the level of confidentiality of information / activities involved in and exhibit integrity in use of dissemination of such information.
Effective verbal and written communication skills are necessary in dealing with a variety of healthcare and finance professionals including senior management staff.
Ability to assess and evaluate complex financial data via use of computer analysis.
Excellent organization and problem-solving skills are required to develop/implement efficient work processes.
Ability to work effectively in a stressful work environment.
Preferred
Healthcare finance experience is preferred.
Company
University of Maryland Medical System
The University of Maryland Medical System (UMMS) was created in 1984 when the state-owned University Hospital became a private, nonprofit organization.
10,001+ employees
H1B Sponsorship
University of Maryland Medical System has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Trends of Total Sponsorships
2023 (13)
2022 (9)
2021 (7)
2020 (3)
Funding
Current Stage
Late StageLeadership Team
Kenneth Kozel
President and CEO
Hank Franey
Executive Vice President and CFO
Recent News
2023-06-30
Company data provided by crunchbase
