Payor Contract Analyst, Intermediate

@ UPMC

Job Overview

UPMC is looking for a Payor Contract Analyst, Intermediate to join our team on a full-time basis with a hybrid work schedule. This role is responsible for evaluating and providing recommendations on health insurance provider contracts and relationships.

Responsibilities

• Prepare advanced reimbursement models (case rates, per diem rates, fee schedules).
• Data mine financial and operational data for analysis.
• Perform testing on advanced payor claims for accuracy and compliance.
• Maintain Top Ten Payor Detail Matrix and Contracted Insurance Matrix.
• Research and respond to internal and payor questions regarding contracts.
• Coordinate research on insurance companies and payor policies.
• Verify payor rate schedule updates for contract compliance.
• Collaborate within the team to achieve optimal outcomes.
• Prepare financial and operational reports to support contractual decisions.

Qualifications

The ideal candidate has healthcare insurance contract experience, strong analytical skills, and proficiency in Microsoft Excel and Word. Required education includes a Bachelor's degree and one year of related work experience, an Associate's degree and three years, or a High School Diploma and five years of related work experience.

Additional requirements include a solid understanding of healthcare terminology, insurance contract language, hospital and professional payment methodologies, and familiarity with Medicare and PA Medicaid reimbursement. Effective written and oral communication skills and teamwork are essential.

Licensure, Certifications, and Clearances

Act 34 certification is required.

Key skills/competency

Payor Contract Analyst, Intermediate, healthcare, reimbursement models, data mining, analysis, Excel, communication, teamwork, compliance