Payor Contracting Analyst
Remote position
Benefits
- Competitive Health & Welfare Benefits
- HSA with qualifying HDHP plans with company match
- 401k plan after 6 months of service with company match (Part-time employees included)
- Employee Assistance Program that is available 24/7 to provide support
- Employee Appreciation Days
- Employee Wellness Events
Minimum Qualifications
- 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.
Essential Functions
- 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
- Knowledge of physician reimbursement.
- Knowledge of provider billing practices.
- Knowledge of CPT codes, modifier rules, CMS payment policies.
SKILLS
- Skill in effective data collection and analysis.
- Skill in designing analyses and appropriate reports.
- High-level attention to detail, accuracy, and organization skills.
ABILITIES
- 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.
3+ years analytic experience in healthcare with physician reimbursement knowledge; intermediate-advanced MS Excel; relational database experience; bachelor's in finance or healthcare administration preferred.
Key Responsibilities
- analyzing physician contracts
- reviewing reimbursement methodologies
- designing analyses and reports
Skills & Tools
Microsoft Excel
Job Details
- Category: Business Operations
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — United States
- Languages: English
Benefits
- 401k matching
- Retirement plan
About The CORE Institute
A healthcare organization providing orthopedic care and related services. — Industry: Healthcare