ABOUT THE ROLE:
- We are looking for a Payor Contract Analyst to join the Contract Modeling division of our Rules and Contracts team
- This team is primarily responsible for developing, analyzing, and maintaining contract models in Cloudmeds new proprietary contract modeling engine, Cloudmed AI
- As a Payor Contract Analyst, you will develop expertise in payor contract structures and contract modeling, resolve continuous improvement requests from project teams, and collaborate with team members on new initiatives in a rapidly growing environment with tight deadlines
WHAT YOU WILL DO (Including, but not limited to...)
- Review and interpret payor contracts to identify all relevant information influencing reimbursement rates and terms
- Create and updates contracts in tools based on agreement done between insurance and hospitals
- Need to create fee schedules and other reimbursement methodologies
- Need to analyze contracts expected reimbursement and maintain accuracy and payor plan coverage
- Enter all terms and details of contract into proprietary software tools to execute pricing
- Design, analyze and maintain healthcare reimbursement models to ensure revenue is in line with the contracts
- Analyze contract modeling engine results to validate reimbursement rates and terms that have been built and configured correctly relative to client data and other inputs
- Report/highlight the exceptions or trends in reimbursement methods
- Effectively communicate the findings with recommendations to project team
- Develop deep expertise in payor contract modeling
- Other related duties as assigned
WHAT YOU WILL NEED:
- Preferably graduate degree in Statistics / Mathematics / Economics / Commerce / Finance from a reputed educational institute General understanding of US healthcare payors, billing, coding
- Good analytical, organizational and time management skills
- Skills to read, understand and interpret reimbursement contracts between hospitals and insurance providers
- Strong computer skills with emphasis on Microsoft Excel, Microsoft Access Good communication skills (both written & verbal); Preferably 1-3 years of experience in US healthcare
- Self-starter who is eager to learn and can work both independently and in a team environment
