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Department
Finance AdministrationJob SummaryUnder the general supervision of the Payor Contracting Director, the Senior Payor Contract Analyst is responsible for overseeing and managing commercial and Medicare Advantage payor contracts. This position serves in a provider relations and roster management capacity for both internal and external stakeholders. The Senior Payor Contract Analyst works closely with the Medical Affairs provider credentialing team, Revenue Cycle (including Hospital Physician Business Services, Coding, Patient Access, Reimbursement and other related departments), Finance department and external commercial insurance payor representatives. This position collaborates internally and externally to understand and improve provider rosters, provider data, provider configuration, claims denials, operational issues and payor contractual requirements.
Essential Functions:
- Ensures the payor contracting department possesses relevant knowledge of commercial and Medicare Advantage payor enrollment requirements and develops and maintains provider rosters issues and a mechanism for resolving enrollment issues. (35%)
- Collaborates with Medical Staff Office to collect and submit accurate information for the provider directories; updates, audits and sends provider rosters to commercial payers in compliance with payor standards. (20%)
- Develops strong relationships with internal and external customers and serves as a liaison between payors and internal departments such as Revenue Cycle, Registration, Patient Access and Medical Staff Office to resolve issues related to provider roster issues, contracting, billing, payments and registration. (20%)
- Conducts financial analyst and cost comparison for payor contract negotiations. Negotiates single case agreements to capture financial reimbursement from non-contracted entities. Supports Payor Contracting Director in contract negotiations. (15%)
- Responsible for facility credentialing (5%)
- Completes other assigned special projects and research. (5%)
Education:
- Bachelor's Degree Required or
- High School Diploma or GED and 7-10 years of experience in contract management, provider relations or provider enrollment in lieu of bachelor's degree. Required
Work Experience:
- 7-9 years in provider relations, payor contracting, provider enrollment, payor configuration or provider-facility credentialing Required
Licenses:
- EPICPA-EPIC Provider Administrator - DHHA - Denver Health and Hospital Authority
Knowledge, Skills and Abilities:
- Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills. Strong ability to articulate complex issues to broad audience.
- Strong knowledge of commercial and Managed Medicare contracts is required. Understanding of provider data fields open/closed panel, taxonomy, hospital based, PCP, Specialist, provider directories as well as services line and CPT procedures.
- Working knowledge of billing, reimbursement and general revenue cycle management strategies.
- Excellent organizational skills, detail oriented and have a strong ability to multi-task.
- Utilizes software applications and working knowledge of the following information systems to include accessing information, updating, correcting and/ or deleting data. General knowledge related to various software applications and their capabilities. Microsoft Office applications: Word, Excel, PowerPoint and Outlook and other applications as needed.
- Ability to independently define problems and develop relative solutions, collect data, establish facts, and draw valid conclusions.
Shift
Days (United States of America)Work Type
RegularSalary
$65,190.00 - $97,785.00 / yrBenefits
Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans
Free RTD EcoPass (public transportation)
On-site employee fitness center and wellness classes
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education & development opportunities including career pathways and coaching
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer
Our Values
Respect
Belonging
Accountability
Transparency
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.
As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For more about our commitment to diversity visit:
"Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class."