Payor Analyst
Newport News, VirginiaFor over 100 years, at Riverside Health System, we have made it our mission to care for others as we would care for those we love.
OverviewProvides financial and business analysis related to payer negotiations, strategic planning, clinical and quality incentive programs, and contract monitoring.
Utilizes a variety of financial and business applications on multiple platforms and interacts with a variety of departments within the organization, along with representatives from commercial and government payers.
Organizes and analyzes large data bases, creates financial models, reports writing, and problem identification and analysis.
What you will do Develops complex payer contract models during negotiations and the ongoing analysis and reporting of payer performance, and payment integrity (over/under payments).
Effectively communicates findings in an accurate, professional, and actionable manner.
Performs as a high functioning member of the Payer Relations team to include credentialing, issue resolution, research, payer monitoring, revenue integrity, contract maintenance, education, departmental documentation, and communication to operational areas.
Serve as a subject matter expert to revenue cycle, operational areas, quality, service lines, and IT for reimbursement, payer policies, and value based programs.
Supports the implementation of contract management systems by interpreting payor reimbursement methodologies, verifying payor contracts are loaded correctly, and researching and providing actionable solutions to contracts that are incorrectly pricing payer claims data.
Utilizes skill and expertise in internal and external data acquisition, validation, and reporting methodologies.
Researches and determines financial impact of payor policy changes on reimbursement and profitability of new services or procedures.
Develops and maintains positive relationships with internal and external stakeholders.
QualificationsEducationBachelors Degree, Finance/Accounting/Economics or related field (Required)Experience3-4 years Experience with healthcare reimbursement and analytics (Required)Licenses and CertificationsCertified Specialist Payment & Reimbursement - Healthcare Financial Management Association (Preferred)As a Riverside Health System team member, our benefits have you covered:
Health & Wellness:
Medical Plan Options Vision and Dental plans (including orthodontic care) Wellness & fitness center discounts Onsite pharmacy and delivery options Riverside Health System services discount Flexible spending and savings accounts Healthy lifestyle incentives Peace of Mind:
Group Term Life and AD&D Insurance Short Term Disability Whole Life Insurance Critical Illness Insurance Accident Insurance Legal Insurance Pet Insurance Financial Support:
CEUs (MedBridge Education) 403(b) Savings Plan (Immediate Matching) Specialty Certification Financial Assistance Company Wide Bonus Program Employee Help Fund Work-Life Balance:
Paid Time Off (full- and part-time team members) Extended illness bank Care.
com membership Employee Assistance Program Adoption Assistance Area retail discounts Community involvement opportunities Recommended Skills Claim Processing Contract Management Credentialing Data Analysis Data Collection Economy Estimated Salary: $20 to $28 per hour based on qualifications.
OverviewProvides financial and business analysis related to payer negotiations, strategic planning, clinical and quality incentive programs, and contract monitoring.
Utilizes a variety of financial and business applications on multiple platforms and interacts with a variety of departments within the organization, along with representatives from commercial and government payers.
Organizes and analyzes large data bases, creates financial models, reports writing, and problem identification and analysis.
What you will do Develops complex payer contract models during negotiations and the ongoing analysis and reporting of payer performance, and payment integrity (over/under payments).
Effectively communicates findings in an accurate, professional, and actionable manner.
Performs as a high functioning member of the Payer Relations team to include credentialing, issue resolution, research, payer monitoring, revenue integrity, contract maintenance, education, departmental documentation, and communication to operational areas.
Serve as a subject matter expert to revenue cycle, operational areas, quality, service lines, and IT for reimbursement, payer policies, and value based programs.
Supports the implementation of contract management systems by interpreting payor reimbursement methodologies, verifying payor contracts are loaded correctly, and researching and providing actionable solutions to contracts that are incorrectly pricing payer claims data.
Utilizes skill and expertise in internal and external data acquisition, validation, and reporting methodologies.
Researches and determines financial impact of payor policy changes on reimbursement and profitability of new services or procedures.
Develops and maintains positive relationships with internal and external stakeholders.
QualificationsEducationBachelors Degree, Finance/Accounting/Economics or related field (Required)Experience3-4 years Experience with healthcare reimbursement and analytics (Required)Licenses and CertificationsCertified Specialist Payment & Reimbursement - Healthcare Financial Management Association (Preferred)As a Riverside Health System team member, our benefits have you covered:
Health & Wellness:
Medical Plan Options Vision and Dental plans (including orthodontic care) Wellness & fitness center discounts Onsite pharmacy and delivery options Riverside Health System services discount Flexible spending and savings accounts Healthy lifestyle incentives Peace of Mind:
Group Term Life and AD&D Insurance Short Term Disability Whole Life Insurance Critical Illness Insurance Accident Insurance Legal Insurance Pet Insurance Financial Support:
CEUs (MedBridge Education) 403(b) Savings Plan (Immediate Matching) Specialty Certification Financial Assistance Company Wide Bonus Program Employee Help Fund Work-Life Balance:
Paid Time Off (full- and part-time team members) Extended illness bank Care.
com membership Employee Assistance Program Adoption Assistance Area retail discounts Community involvement opportunities Recommended Skills Claim Processing Contract Management Credentialing Data Analysis Data Collection Economy Estimated Salary: $20 to $28 per hour based on qualifications.
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