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Insurance Contracts and Payer Relations Analyst

Company: St. Luke's University Health Network
Location: Allentown
Posted on: May 22, 2023

Job Description:

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.The Insurance Contracts and Payer Relations Analyst is responsible for coordination of all Network insurance contract details. Provides assistance, as required, for all contract-related analyses using necessary and appropriate financial data to ensure sound contracting decisions. Assists in the review of insurance contracting language to ensure on-going compliance to contract terms by both Network and Payer.
JOB DUTIES AND RESPONSIBILITIES:

  • Responsible for coordinating all contract-related details utilizing appropriate tools to ensure compliance with contract terms.
  • Develops timely and accurate calendars of key contract dates that require communication/interaction with insurance companies.
  • Assists in the detailed review of contract language to ensure contract can be administered, limit legal exposure, ensure appropriate defined criteria in terms of business office, case management, charge master, coding, etc.
  • Assists in the implementation and administration of payer contracts within the parameters established by the Network Director and the Vice President of Finance.
  • Maintain payer specific problem/issues list for all insurance companies under contract
  • Supports the revenue cycle and clinical areas of the hospital by researching payer specific issues and, as necessary, contacting payer for problem resolution.
  • Coordinate and participate in regular meetings with Payer Provider Representatives to discuss/resolve issues.
  • Supports CBO Contract Management analysts by researching payer contract questions and discrepancies to ensure Contract Management IMAX system accuracy and hence, correct claims valuation.
  • Ongoing review of the Contract Management document database to ensure accuracy and completeness.
  • Responsible for the dissemination of payer communications to appropriate departments related to payer restrictive policies, contract changes/terminations/additions, etc.
  • Assist the Network Director in production and analysis of payer specific data from the Contract Management system to identify payment trends and issues.
  • Stays abreast of governmental payment legislation and evaluates contractual arrangements for applicability/opportunity (i.e. Medicare/Medicaid managed care plans).
  • Assist the Network Director in developing and maintaining a strong professional relationship with the payer community. - Meets on a regular basis with payer team and involves appropriate internal staff as necessary.
  • Strives for customer service excellence by treating all patients, co-workers, physicians and visitors with sensitivity, dignity and respect.
    PHYSICAL AND SENSORY REQUIREMENTS:
    Sitting for up to 8 hours per day, 3 hours at a time. - Consistent use of hands and fingers for typing, telephone, data entry, etc. - Occasional twisting and turning. - Uses upper extremities to lift and carry up to 10 pounds. - Stoops, bends and reaches above shoulder level to retrieve files. - Hearing as it relates to normal conversation. - Seeing as it relates to general vision. - Visual monotony when reading reports and viewing computer screen.

    EDUCATION:Bachelor's -degree in Business or Health Care Administration preferred or Five (5) years of experience in health care contract administration.
    TRAINING AND EXPERIENCE:
    Three (3) to Five (5) years of hospital or physician practice business office and/or health care contract administration experience including identifying and maintaining compliance with contract terms, strong quantitative, analytical skills and well-versed in contract implementation; knowledgeable regarding analytical tools and techniques, including report writers, spreadsheet, database software, and graphical presentation software.

    Please complete your application using your full legal name and -current home address. -Be sure to -include -employment history for -the past seven (7) years, including your present employer. - Additionally, you are -encouraged to upload a current resume, including all work history, education, and/or certifications and -licenses, if applicable. -It is highly recommended that you create a profile at the conclusion of submitting your first application. -Thank you for your interest in St. Luke's!!

Keywords: St. Luke's University Health Network, Allentown , Insurance Contracts and Payer Relations Analyst, Professions , Allentown, Pennsylvania

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