Payor Relations And Contracts Analyst

The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state's future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System's anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit www.umms.org.

General Summary

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 senior contract analyst 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 senior contract analyst 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

Education and Experience

1. 1. Bachelor’s degree in Finance, Accounting or a related field, or equivalent experience is required.
2. 1. Two (2) years’ experience in financial and data analysis required. Healthcare finance experience is preferred.
3. 1. Knowledge of Medicare and commercial payer reimbursement methodologies and CPT (Current Procedural Terminology)/HCPCS (Healthcare Common Procedure Coding System) is preferred.

Knowledge, Skills and Abilities

1. 1. 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.
2. 1. Knowledge of payer contracts to include terminology and reimbursement methodologies.
3. 1. 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.  
4. 1. Ability to judge the level of confidentiality of information / activities involved in and exhibit integrity in use of dissemination of such information.
5. 1. Effective verbal and written communication skills are necessary in dealing with a variety of healthcare and finance professionals including senior management staff.
6. 1. Ability to assess and evaluate complex financial data via use of computer analysis.
7. 1. Excellent organization and problem-solving skills are required to develop/implement efficient work processes.  
8. 1. Ability to work effectively in a stressful work environment..

Required Physical and Environmental Demands

1. Works in a standard office environment.
2. Some travel may be required.

All your information will be kept confidential according to EEO guidelines.