Payer Insights Analyst

Description

JOB SUMMARY

The Payer Insight Analyst will partner with internal and external stakeholders in order to provide data driven input that will optimize payer recovery. You will closely examine payer contracts, proactively data mine accounts, review, and research payment account adjudication, and enable action before trends impact client performance. Leveraging revenue cycle data, you will manage a portfolio of payers and be assigned projects to improve revenue cycle performance and provide value to our clients.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Apply moderately complex quantitative methods to proactively data mine / interpret data and present the key trends and recommendations to appropriate stakeholders.
• Perform high level contract overview to ensure accuracy of contract terms and conditions. Solid understanding of healthcare reimbursement methodologies, analyze data findings, and be able to escalate issues as needed.
• Prepare groups of accounts based on logged information to provide stakeholders with clean actionable issues to drive payer results. Coordinate efforts with stakeholders to drive changes in auto adjudication, aging and cycle time.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Strong analytical and quantitative skills
• Self-starter who can work both independently and collaborate in a team environment
• Independent, logical thinker with proven ability to perform detailed data analysis and make sound decisions
• Intermediate knowledge of managed care and other healthcare contract language
• Intermediate knowledge of healthcare reimbursement and patient accounting principles
• Intermediate understanding of ICD-10, HCPCS/CPT coding, medical terminology, hospital billing form requirements (UB-04), and electronic remittance advice (ERA/835) responses
• Demonstrated ability to detect patterns in large volumes of data
• Strong communication skills (verbal and written)
• Strong relationship building and collaboration skills
• Capability to multi-task, be organized, and meet critical deadlines

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

• Bachelor’s degree required in Healthcare Administration, Business, Computer Science, Mathematics or related discipline
• 2-4 years working in a managed care or healthcare environment with end-to-end revenue cycle experience
• 1-2 years experience in analysis of payer trends and proven track record of using data to provide actionable business results
• Fluent in data fundamentals: SQL, data manipulation and modeling
• Healthcare and/or revenue cycle experience in a provider, servicer or a large physician-practice experience a plus
• Proficient in Microsoft excel, word, powerpoint, and sharepoint

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position, use computer and answer telephone
• Ability to travel
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Office Work Environment
• Hospital Work Environment

OTHER

May require travel – approximately 25%.

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

Compensation and Benefit Information

Compensation

• Pay: $51,626.00 - $77,438.00 annually. Compensation depends on location, qualifications, and experience.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, life, and business travel insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.