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Senior Contract Analyst

Company: SoNE HEALTH
Location: Hartford
Posted on: May 7, 2022

Job Description:

Job DescriptionSUMMARY OF RESPONSIBILITY:The Senior Contract Analyst position is responsible for performing contract analytics, evaluating results and making recommendations to Management. The position develops, analyzes, interprets and reports managed care contract rate proposals providing recommendations to the Chief Contracting Officer, Directors, Payor Partnerships, Manager, Contract Analytics and the Contract Administrators. The position also provides guidance to Contract Analysts to ensure accurate modeling results and financial outcomes. The position leads the design, development and maintenance of payor scorecards to monitor contract performance and support contract compliance. The position serves as a resource for contract and financial analysis for other departments in the organization and works directly with those departments and payors to manage problem resolution and ensure availability of accurate and timely information. The position must maintain positive relationships with payors and providers and assist with the communication of agreements to providers and key staff across Trinity Health Of New England, including educating the providers and staff on key terms within the agreements. Primary scope of work includes regional hospital, physician and ancillary provider contracts and Commercial, Managed Medicare and Managed Medicaid lines of business. Essential Functions:

  • Conducts detailed managed care contract modeling and analysis utilizing current contract modeling systems in place, in support of contract negotiations and ongoing management. Contracts include fee for service and value-based models that cover physician, hospital and ancillary providers/services.
  • Evaluates third party contracts developing financial models to ensure financial viability of agreements.
  • Identifies opportunities (low cost coverage, low relativity to Medicare rates, rate parity) to optimize contractual performance and makes recommendations to leadership.
  • Presents contract analytics and other reimbursement related data to key individuals within the organization including THOfNE hospital and physician leaders.
  • Ensures timeliness of negotiations by providing data within negotiation timeline.
  • Provides guidance to staff concerning financial analysis and interpretation of reimbursement data.
  • Assists Manager of Contract Analytics with the development, implementation and monitoring of new reports and procedures that will improve operational effectiveness of the department.
  • Maintains and evaluates payor matrices including key comparative metrics, contract terms, and renewal dates for use by management team.
  • Ensures hospital contract management system and physician modeling tools are up to date with current rates, fee schedules, groupers, codes, etc.
  • Stays current with the changes in reimbursement models as it relates to value based contracting models.
  • Keeps current with changes in coding, regulatory changes and payment policies affecting hospitals and other providers/Maintains competencies and expertise relative to both governmental (i.e., Medicare) and private payer payment trends.
  • Acts as lead providing data and analytical support with respect to SOHO initiatives aimed at new reimbursement models (i.e., bundled payment initiatives, risk based contracting, etc.).
  • Prepares ad hoc reports, analyses and supportive data at the request of the Manager, Contract Analytics.
  • Participates in payor Joint Operating Committee meetings (JOC) and payor relationship meetings as necessary. Other Functions:
    • Maintains physician fee schedules and/or hospital reimbursement schedules.
    • Assesses rate compliance and monitors all changes made to contract terms.
    • Performs other duties as assigned.
    • Bachelor's degree in health care management, finance or related field is required.
    • Master's degree in Accounting, Finance, or Business Administration preferred.
    • HFMA Managed Care, Finance or other related Certifications preferred.
    • Five or more years of experience of healthcare contracting or analysis is required.
    • Detail oriented with strong communication and presentation skills is required.
    • Solid working knowledge of contractual, health insurance and operational issues related to managed care organizations, physician groups, hospitals and health insurance benefit plan designs is required.
    • Solid working knowledge of healthcare data such as claims, provider, eligibility data as well as clinical quality algorithms for Commercial, Medicaid and Medicare products is required.
    • Strong understanding of managed care terms and alternative payment model metrics and gain share mechanisms (PMPM, capitation, utilization, quality and healthcare cost data) is required.
    • Strong working knowledge of MS Office suite applications is required.
    • Demonstrated experience using analytical reporting tools, e.g. Microsoft Excel, Access and Crystal Reports is required.
    • Experience with Contract Modeling systems is required.
    • Excellent critical thinking/problem solving skills.
    • Effectively anticipates needs and problems. Recognizes capabilities and utilizes others/resources to optimize patient care.
    • Self-directed, organizes and prioritizes work and manages multiple tasks and assignments. Manages time well and performs assigned duties with attention detail, accuracy and follow-through with minimal supervision.
    • Deals with confidential information in a professional manner.
    • Skilled at working closely in fast-paced, multi-disciplinary, team environment.
    • Must be highly mobile, able to access all areas of the premises; ability to travel outside of work premises through the state, and outside the state as needed.
    • Regularly required to use hands to finger, handle or feel objects, tools, or controls; reach with hands and arms; and talk or hear.
    • Frequently is required to walk and sit.
    • Occasionally required to stand; climb or balance; and stoop, kneel, crouch or crawl.
    • Ability to lift and/or move up to 20 pounds.
    • Vision abilities required by this job include close vision, color vision, peripheral vision, depth perception and ability to adjust focus.
    • The dexterity necessary to utilize a computer keyboard on a regular basis is essential.§ Prepares and presents documents required by the Trinity Health Payor Contracting Oversight Committee (PCOC). § Assists in the maintenance and scanning/storage of all executed agreements. The duties listed above are intended only as illustrative of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar or a logical assignment to the position.QUALIFICATIONS AND COMPETENCIES:Physical and mental requirements:The Physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Keywords: SoNE HEALTH, Hartford , Senior Contract Analyst, Accounting, Auditing , Hartford, Connecticut

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