Senior Contract Analyst
Company: SoNE HEALTH
Posted on: May 7, 2022
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
- 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
- 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
- Assesses rate compliance and monitors all changes made to
- 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
- HFMA Managed Care, Finance or other related Certifications
- 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
- 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
- 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
- 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
- Skilled at working closely in fast-paced, multi-disciplinary,
- 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
- 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
- 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
Keywords: SoNE HEALTH, Hartford , Senior Contract Analyst, Accounting, Auditing , Hartford, Connecticut
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