• UPMC
  • $106,890.00 -113,690.00/year*
  • Pittsburgh , PA
  • Legal
  • Full-Time
  • 4870 Forbes Ave


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Description

Purpose:

Under limited supervision, responsible for evaluating and providing recommendations regarding health insurance provider contracts and relationships.

Responsibilities:

  • Coordinate the process of research on insurance companies and other payors medical policies, billing policies, contracted reimbursement rates and related issues to assist in evaluating and modeling payor financial performance in order to maintain or develop new or enhanced revenue streams.

  • Data mine provider and payor financial and operational data population for analysis. Define the necessary data elements required for the project.

  • Interact as a team member of the department to achieve maximum outcomes.

  • Maintains Top Ten Payor Detail Matrix and Contracted Insurance Matrix for all hospitals.

  • Perform testing on advanced payor claims to ensure accuracy and compliance to contract terms.

  • Prepare advanced reimbursement models, including but not limited to, case and per diem rates, cost and day outliers, and advanced fee-for-service fee schedules for the purpose of determining payor contract proposed terms as compared to current contractual terms and other comparable payor contract terms.

  • Prepares financial and operational activity reports to support contractual decisions including assumptions and observations.

  • Researches and responds to moderately complex internal UPMC entities and payor questions as they relate to contracts.

  • Verification of payor rate schedule updates for compliance to contract terms.

Qualifications

  • Bachelors Degree in Finance, Business, or related business field is required.

  • Minimum two (2) years experience in healthcare managed care contracting and /or health care insurance provider contracting, and/or financial and medical analysis or revenue cycle experience is required.

  • Solid understanding of healthcare terminology, insurance contract language and hospital/professional payment methodologies including a general understanding of Medicare and PA Medicaid reimbursement.

  • Advanced working knowledge of Microsoft Excel, Cognos, Crystal and familiarity with Word and Access, preferred.

  • Must have solid analytical skills.

  • Must have solid written and oral communication skills.Must be an effective team player.

Licensure, Certifications, and Clearances:

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities REQNUMBER: 724281


Associated topics: attorney corporate, business, company, corporate, counsel, courtroom, lawyer, legal, legal department, market

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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