Contract Analyst

Responsible for performing all contract management functions for all Payers.

This position will serve as a liaison between Carris Health's Revenue Cycle Leadership and all

Insurers and other Third Party Payers [contracted and non-contracted] to foster relationships

and address contractual details, payment discrepancies, etc. in order to support an efficient

and profitable Revenue Cycle, and to ensure that reimbursement remains accurate according

to contract terms. Provides advice on how to proceed in complex cases when contract

guidelines and language need clarification.


• KEY FUNCTIONS: Primary responsibilities include:

 All Contract Management functions, contract build, maintenance, support, and other

related responsibilities within both Rycan and Epic Systems.

o Serve as inter-departmental liaison for all Contract Management-related issues

(Payer issues, Reimbursement discrepancies, etc.)

o Serve as a primary contact for all related Payer and Vendor representatives

(excluding contract negotiations)

o Assist supervisor with summarizing and presenting contractual issues in

meetings with Payer Representatives, and provide lists of encounter examples

that support these finding

o Research all contractual and underpayment issues

o Responsible for recovering contractual underpayments

 Payer Specialist, keep informed of payer updates and analyze how changes impact

Carris Health.

 Assist in negotiating contracts, maintaining contract management software, analyzing

financial impact, and monitoring payments for Payer compliance of rates and terms.

 Analyze third-party contractual allowances for inclusion in financial statements.

 Assist in the preparation, processing, research, and analysis of Medicare, Medicaid, and

managed care cost reports to ensure the accuracy of claim payments.


• JOB RELATIONSHIPS:

A. REPORTS TO: Contracting and Payer Relations Supervisor

B. SUPERVISES: None

C. INTERRELATIONSHIPS WITH: Finance, Business Office, Clinical Department leadership,

Physicians, and other Clinical Staff


• HOURS OF WORK: 8:00am to 4:30pm -- 5 days a week, flexible schedule


• DRESS CODE: Per Department Dress Code (Office attire)


• ESSENTIAL REQUIREMENTS OF WORK (Minimum qualifications necessary to function at full

productivity).

A. EDUCATION AND TRAINING: College degree preferred. Minimum of two year associates degree or equivalent experience in a Healthcare setting. Requires advanced knowledge of claims processing system, Electronic Health Record, Microsoft Office applications (particularly Microsoft Excel), and other technology as assigned. B. EXPERIENCE: Previous office experience and knowledge of Revenue Cycle, Epic applications, Contract Management, and Third Party Payers preferred. Specific experience related to medical terminology, charge documentation, coding, auditing, and Payer contracts a plus. C. JOB KNOWLEDGE (Specific): Overall knowledge of business office procedures and health system policies. General knowledge of Patient Access, HIM, Billing & Collections, Cashiering, and Data Entry functions and how they influence each other and operate within the Hospital Electronic Health Record system. Strong problem-solving, interpersonal, analytical, communication and computer skills required. Ability to effectively use and integrate all necessary software systems a must. Emphasis on confidentiality and accuracy of information. Must be a quick learner, a self-starter and able to work independently.


• BUDGET: N/A


• CLIENTELE DIRECTLY AFFECTED BY JOB: Other hospitals, clinics, business office, clinical

leadership, patients, and other hospital staff.


• PHYSICAL DEMANDS OF THE JOB: Minimal physical demands

1. Continuous sitting occurs while working at a work station, using a computer, and attending meetings

2. Frequent use of a telephone while holding it in the non-dominant hand and using the dominant hand for writing or using a keyboard

3. Occasional forward reaching from floor to above the shoulders - to file papers and remove them as needed. Approximate range is 60" from the floor


• PHYSICAL ENVIRONMENT OF THE JOB: Usual working conditions involving adequate light,

temperature, ample desk space, etc.


• EQUIPMENT OR MACHINES USED ON THE JOB: Computers, web-based applications, internal

software applications, printer, scanner, external storage devices, telephone, calculator, copy/fax

machines, and other technology as necessary.

X
• MENTAL DEMANDS OF THE JOB:

A. JUDGEMENT AND INITIATIVE:

 Knowledge of the Revenue Cycle.

 Demonstrates ability to analyze information, plan effective actions and follow through reliably to meet expectations.

 Effective oral and written communications skills.

 Functions independently and as team member.

 Able to prioritize work projects and complete them in a timely manner.

 Has knowledge of healthcare systems and organizational relationships.

 Strong investigative, analytical, organizational, and critical thinking skills

B. INDEPENDENT ACTION: Organizational skills needed to work and function independently with minimal supervision. Self-motivated, ability to set priorities and complete tasks on a timely basis. Ability to handle information in a confidential manner and work effectively and objectively with both Clinical and Non-Clinical staff C. EFFECT OF ERROR: Adverse affect on the Revenue Cycle affecting performance results, cash flow, staff morale, productivity, and public relations. In addition, inaccurate data is unacceptable and must be prevented at all costs whenever possible, as it presents the possibility of inhibiting issue recognition and resolution and can negatively impact public relations, patient satisfaction, etc. D. CONTACT WITH OTHERS: Health system employees, department directors, payers and

patients.

X
• PRINCIPAL JOB RESPONSIBILITIES, TASKS, AND AUTHORITIES: A. RESPONSIBILITY: Contract Management

PRIORITY: A % OF TIME: 40% DISCRETION: A TASKS: 1. Ensure that Payer contracts are built in contract management software, are

continuously updated and reflects all contracted rates for all Payers and procedures.

2. Identifies and researches payment variances and works with Payer representatives to resolve.

3. Assists with contract negotiations including modeling proposals in contract management software.

4. Maintains communication to other staff who may be impacted by contract

changes.

B. RESPONSIBILITY: Underpayment Recovery

PRIORITY: A % OF TIME: 40% DISCRETION: A TASKS: 1. Identifies potential underpayments through comparison of Payer contracts to

claim data to determine accuracy of reimbursement. 2. Reviews system's contracts to determine appropriate application of rates,

provisions and terms. 3. Manages assigned workload of accounts flagged for potential underpayments.

Aggregates common infractions across multiple claims to maximize recoveries. 4. Notifies Payer of potential underpayment and works to recover lost

reimbursement. 5. Develops and maintains tool to identify and track successes of underpayments. 6. Researches and identifies areas of opportunity for change.

C. RESPONSIBILITY: Review Paper Remittance

PRIORITY: B % OF TIME: 10% DISCRETION: A TASKS: 1. Review paper remittances daily to ensure claims are paid and posted

appropriately. D. RESPONSIBILITY: Payer Specialist

PRIORITY: C % OF TIME: 5% DISCRETION: C TASKS: 1. Research and stay up to date on Payer policies, requirements and updates. 2. Maintain knowledge related to regulatory reviews and other communications.

E. RESPONSIBILITY: Payer Report Cards

PRIORITY: A % OF TIME: 5% DISCRETION: A TASKS: 1. Work directly with Contracting and Payer Relations Supervisor to develop and

maintain individual Payer report cards. 2. Assist in supporting, analyzing, and researching issues with various Payers.

F. RESPONSIBILITY: Other Duties as Assigned

PRIORITY: C % OF TIME: DISCRETION: C Tasks: Responsible for running, analyzing and producing reports for management including but not limited to: 1. Attends monthly staff meetings. 2. Maintains good public relations 3. Answers telephone inquiries 4. Perform other duties as assigned.

G. RESPONSIBILITY: Service Excellence TASKS:

1. Demonstrate an ongoing commitment to the Service Excellence philosophy by

adhering to and promoting behaviors outlined in "Standards of Excellence".

H. RESPONSIBILITY: Continuous Quality Improvement TASKS:

1. Demonstrates understanding of the CQI philosophy. 2. Participates in CQI training activities or CQI teams if appropriate. 3. Demonstrates sensitivity to customers and their needs. 4. Interacts appropriately with internal customers, i.e. coworkers within

department, staff across departments. 5 Interacts appropriately with external customers, i.e. patients, families, medical

staff, vendors. 6. Role models positive behaviors.

I. RESPONSIBILITY: Safety TASKS:

1. Maintain and promote a safe environment for all patients, visitors and staff. 2. Consistently follow all policies, practices and work rules. 3. Do not use shortcuts or work-arounds that may reduce safety or increase risk. 4. Stay alert, act responsibly and use common sense to reduce risks. 5. Report actual events and good catches as soon as possible. 6. Create a safe environment by eliminating hazards and identifying and reporting

unsafe systems. 7. Complete all mandatory safety education, attend safety sessions, review and

understand the Safety Program (available on RiceNet). Seek answers to questions you have about the Safety Program.

AUTHORITIES: The employee has the authority to complete and carry out the above tasks according to department procedure.

SPECIFIC DEMANDS OF THE JOB

Never

Rarely (1-5%) Up to 1 hr

Occasionally (6-33%) Up to 2.5 hrs

Frequently (34-66%) 2 - 5 hrs

Continuously (67 -100%) Over 5 hrs