Job Posted June 23, 2022

Senior Payor Contracting Operations Analyst – Remote in WA State

Opening with Proliance Surgeons, Inc.
Job Role: Administrative
Job Type: Full Time

Overview

Position Summary

The Senior Payor Contracting Operations Analyst will be responsible for all contract administration, and customer support for Proliance Care Centers. Customer support will entail answering questions on network status, referrals, authorizations, reimbursement amounts, payor policies and edits, as well as any other needs. This position will work directly with Provider Representatives to resolve high level payment issues and disputes. Additionally, this role will monitor payment policies and procedures and distribute to Care Centers.

• Using Excel, Access, or other data analysis tools, develops analyses to support decision making.
• Acts as liaison between corporate and care centers for billing and reimbursement issues.
• Maintains a working knowledge of applicable Federal and State reimbursement laws and regulations as well as payor payment policies and procedures.
• Identifies changes in regulations and payor policies on a timely basis. Communicates changes to care centers.
• Interprets contracts, models the fee schedule, loads the fee schedule into our EMR.
• Research payor code edits, authorizations, and referral requirements.
• Monitors any monthly, quarterly, or yearly changes to CMS fee schedules, calculates the impact to each contract, updates the fee schedules accordingly.
• Research payor network status.
• Contributes to data integrity initiatives.
• Maintains corporate insurance manual.
• Participate in calculating reimbursement amounts and analyzes payment discrepancies.
• Interprets contracts to support care center questions.
• Maintains payor documents and creates references.
• Maintains intranet for payor contracting.
• Attends and participates in internal and client meetings as needed.
• Engages in process and quality improvement activities to minimize manual efforts.
• Assists Rev Cycle on an as needed basis.
• Performs other duties as required by management.

• Superior customer service skills
• Great interpersonal skills; demonstrating patience, composure and cooperation; working well with physicians and staff.
• Ability to exhibit cooperation, flexibility, and provide assistance when interfacing with physicians, management and staff.
• Ability to meet strict deadlines.
• Skill in organizing and reporting information that is accurate and complete.
• Consistency and timeliness in attendance
• Ability to communicate effectively using data with all levels of the organization.
• Excellent judgment understands what s/he does not know and what questions to ask to reach a well-informed decision and or when to escalate to the appropriate department.
• Self-motivated team player able to multi-task and prioritize.
• Ability to work independently, multi-task

• Bachelor’s degree or greater in Finance, Accounting, Business Administration, Healthcare Management, or related field.
• Minimum of 5 years’ experience working in the healthcare industry. Payor contracting/ healthcare analytics background preferred.
• Experience working in physician practices.
• Knowledge of coding conventions i.e. (Revenue Codes, Occurrence Codes, ICD-9, ICD-10, CPT and HCPCS codes).
• Knowledge of the various types of health insurance payers: Medicare, Medicare Advantage Plans, Commercial, Medicaid, and Medicaid Managed Care.
• Broad ranging knowledge of ASC’s, Clinics, and Ancillary Services.
• Familiar with payor payment policies, authorizations, and referrals

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

• Sitting for extended periods of time.
• Manual dexterity required for use of computer keyboard.
• This position may be stressful at times.
• Working 40 hours per week. Some responsibilities may require longer work hours in order to complete assignments.

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

The work environment/physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time.

How we are protecting team members from COVID-19?
Employee and patient health and safety is our top priority. At Proliance, we are adhering to CDC, State and local orders regarding COVID-19 and have implemented processes and precautions across our facilities to prevent the spread of COVID-19.

Following the most recent vaccination mandate for healthcare workers in Washington State, and our commitment to the health and safety of our employees and patients, all Proliance employees will be required to provide proof of full vaccination upon hire, or proof of a medical or religious exemption.

Proliance Surgeons offers a generous benefits package including Medical/RX, Dental, Vision, 401k with profit sharing and more! Plus ALL of our employees enjoy the free perks of our employee purchasing program offering a variety of discounts on purchases made every day – including cell phone service!


Proliance Surgeons is proud to be an equal opportunity employer. We are committed to creating an inclusive environment, and we welcome and encourage people of all backgrounds, perspectives, experiences, and skills to apply.


All employment decisions at Proliance Surgeons are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics. 

Care Center

805 Madison St Suite 901
Seattle, WA 98104

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