Company :

Job Description :

GENERAL OVERVIEW:

This role processes payor contracts for single case agreements, manages contract repository, and completes facility credentialing applications. Disseminates payor communications and coordinates projects as assigned. Summarizes contract terms and payor policies for use throughout the organization. Provides accurate hospital, professional, and ASC rate information to Leaders throughout the organization.

ESSENTIAL RESPONSIBILITIES

• Applies knowledge of hospital, professional, and ASC reimbursement to provide accurate and timely pricing information. (25%)
• Supports the Finance Team's reserve model by accurately calculating expected reimbursement for high dollar, complex accounts. (25%)
• Collaborates with Revenue Cycle and Finance Teams on payor policy, contract summary, and pricing requests. (20%)
• Participates in cross-functional teams that evaluate potential new products and new business initiatives. (15%)
• Provides all hospital and professional rate information required for compliance with the CMS price transparency regulation. (15%)
• Perform other duties as assigned or required.

QUALIFICATIONS:

Minimum

• Bachelor's Degree in Finance, Accounting, Business Administration, Economics, Statistics, or related field OR 6 years of relevant experience in lieu of Bachelor's degree.
• 1 year in Finance, Contracting, or Data Analysis
• Microsoft Office (Excel, Powerpoint, etc.)
• Ability to apply various reimbursement methodologies (e.g. CMS IPPS, CMS OPPS, PA Medicaid, etc.) in pricing requests
• Ability to juggle multiple projects at once and manage time effectively, in order to meet established deadlines
• Strong oral and written communication skills
• Ability to independently make progress on key projects with support from supervisor or peer analysts
• Self-starter who takes initiative, and drives progress on major projects with some supervision

Preferred

• Master's Degree in Finance, Accounting, Business Administration, Economics, Statistics, or related field
• 1 year with hospital, physician, and ASC contracts
• 1 year in Healthcare
• Knowledge of healthcare industry, particularly as it relates to hospitals or other providers
• Clinical background or general understanding of hospital/physician practice operations
• Expected Reimbursement Contracts certification

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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