SUMMARY OF RESPONSIBILITY:
The Contract Analyst position is responsible for performing analytics related to contract modeling, negotiation and ongoing management using a variety of tools. The position provides support to the VP Payer Partnerships, Regional Directors, Payer Partnerships, Regional Manager, Contract Analytics and the Contract Administrators with the review, evaluation and preparation of managed care contract rate proposals. The position participates in the design and production of payer report cards 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 payers to manage problem resolution and ensure accurate and timely information is available. The position must maintain positive relationships with payers and providers and may assist with the communication of agreements to providers and key staff across Trinity Health New England, including educating the providers and staff on key terms within the agreements. Primary scope of work includes hospital, physician and ancillary provider contracts and commercial, managed Medicare and managed Medicaid lines of business.
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.
Investigates individual and systematic payment issues identified by department analyses or communicated by providers (e.g. physician practice managers, Revenue Integrity, Finance, etc.). Makes recommendations that address such issues in current and future contracts.
Develops payer matrices including key comparative metrics, contract terms, and renewal dates for use by management team.
Establishes and maintains positive relationships with managed care payers in order to facilitate sharing of information, analyses and other information important to the provider/payer relationship.
Stays current with the changes in reimbursement models as it relates to value based contracting models.
Prepares ad hoc reports, analyses and supportive data at the request of the Regional Manager, Contract Analytics.
Participates in payer Joint Operating Committee meetings (JOC) and payer relationship meetings as necessary.
Communicates to staff of contracting initiatives as well as payer bulletins and changes to billing requirements reimbursement procedures, and medical policies that may impact prior authorization and other established processes.
Assists in the maintenance of physician fee schedules and/or hospital rate schedules.
Assists in the preparation of documents required by the Trinity Health Executive Contracting Oversight Committee.
Assists in assessing rate compliance and monitors all changes made to contract terms.
Assists with preparation of Trinity Health ECOC presentations.
Assists in the maintenance and scanning/storage of all executed agreements.
Performs other duties as assigned.
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:
Bachelor’s degree in health management, finance or related field is required.
Three or more years of experience of healthcare contracting or analysis 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 required.
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 metrics (PMPM, capitation, utilization and average cost) is required.
Strong working knowledge of MS Office suite applications is required.
Demonstrated experience using analytical reporting tools, e.g. Microsoft Excel, Access and Crystal Reports is required.
Experience with Contract Modeling systems preferred
Excellent critical thinking/problem solving skills.
Effectively anticipates needs and problems. Recognizes capabilities and utilizes others/resources to optimize patient care.
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 manner.
Skilled at working closely in fast-paced, multi-disciplinary, team environment.