Contracting Reimbursement Consultant

Duties:

Under the minimal supervision of the Manager, independently leads financial and data analysis to evaluate rate proposals, contract terms, and health plan reimbursement. This position will proactively identify rates, methodologies, and processes that need improvement and will develop and implement solutions to optimize reimbursement.

Lead the development of financial reporting and analysis using tools such as EPSi, SQL, Epic Clarity, and Power BI to extract and analyze data for the purpose of assessing contracted rates and reimbursement methodologies

Generate proactive analysis and make recommendations to Contracting leadership based on review and identification of payer reporting trends.

Lead evaluation, and creation, of metrics and processes to improve and / or track rates aProductst industry averages to identify gaps and areas for improvement.

Manage the rate review process for existing and proposed contracts to evaluate financial impact, verify that all necessary reimbursement terms are addressed, and the rates are depicted as negotiated.

Coordinate with contract modeling team the implementation and maintenance of contract management/pricing systems.

Achieve and maintain data integrity through monitoring financial systems and proactively identifies opportunities to improve processes and increase value of financial activities.

Maintain expertise in reimbursement methodologies, payer policies, and regulatory changes as they apply to payor contracts.

Manage and complete special projects and attends various committee meetings as assigned.

Coordinate and support financial projects for business units across the Health System

Skills:

Coding / billing and experience is preferred Abilities

Strong Analytical and Critically Thinking skills (via curiosity, creativity, skepticism, and adept in use of logic) relative to accomplishing business objective and problem solving

Detail-oriented

Proficient in Microsoft Excel (queries, reports, pivots, What If scenarios and database mgmt. a plus)

Proficient in Data extraction & reporting tools (EPSi, SQL, Clarity, etc...)

Excellent oral and written communication skills

Strong organizational and interpersonal skills

Strong Understanding of Managed Care Reimbursement methodologies, coding and terminology

Shift Hours: Hybrid schedule: in-office on Wednesdays. Willing to have the position be fully remote for an EXCELLENT candidate but they must be in Eastern or Central time zone. Monday through Friday 8a-5pm