Responsibilities

Job Summary

With significant latitude for independent judgment and initiative and for all URMC hospitals and affiliates, the Senior Payer Contracting & Reimbursement Analyst performs complex financial analyses used in critical business decisions. Builds and maintains reimbursement and contract modeling systems. Manages large, multi-hospital contracting and regulatory projects. Supports strategic contract negotiations and makes recommendations to the Director, Payor Contracting & Reimbursement. Represents URMC and all affiliate hospitals with payers. Has comprehensive knowledge of payer reimbursement methodologies, rules, regulations, and contract terms. Reports to the Director, Payer Contracting & Reimbursement.

Key Functions and Expected Performances

With significant latitude for independent judgment and initiative:

30% - Plan, develop, build and maintain reimbursement modeling and contract management systems and perform complex financial analyses for use by URMC senior executives and program managers in profit and loss statements and to support critical business decisions. Manage decision support and contract management software programming logic. Insure accuracy of financial data by performing reconciliations. Perform data mining, identify trends, interpret data, and make recommendations to senior leaders.

20% - Manage large, multi-hospital projects and financial analyses required for contract and regulatory compliance including systems implementations . Examples include: charge creep analytics, price transparency, and payment method conversions. Using project management skillset, lead cross-functional teams in contract implementations and revenue cycle management initiatives. Define and develop required financial reporting and analytics.

20% - Routinely develop, review and analyze financial reports for complex payor contracts. Support effective contract negotiations through review of language, modeling of proposed terms and rates and make recommendations to Director, Payer Contracting & Reimbursement. Negotiate select payor contracts with management direction. Prepare financial payor models and benchmark comparisons to support contractual decisions including assumptions, observations, conclusions and recommendations.

10% - Support URMC business decisions by maintaining expert knowledge of 3 rd party & government payer reimbursement, rules, regulations, coding, contract terms and conditions. Advise revenue cycle managers and programmers on EPIC set up of contracting systems. Educate and communicate payor methodology and/or rate changes to the appropriate internal URMC entities and/or department staff. Verification of payor rate schedule updates for compliance to contract terms. Perform testing on complex payor claims to ensure accuracy and compliance to contract terms. Research and respond to complex internal and payor questions as they relate to contracts. Attend meetings with payors and other URMC entities and /or departments to resolve contract issues when requested.

10% - Provide consultation to Director, Payer Contracting& Reimbursement regarding payer/financial developments for planning, control and analytical processes. Develop product pricing and utilize financial modeling in making rate decisions especially for new technologies. Negotiate single case agreements with non-par payers, ensuring appropriate terms/conditions. Work with Compliance Analysts, Office of Counsel, and Medical Staff Office managers regarding credentialing and payer provider file issues. Provide input in the development and implementation of systems and/or new technologies, e.g. EPIC, Syntellis Decision Support Analytics and nThrive Contract Management in collaboration with Decision Support Analytics teams.

10% - Mentor, t rain & assist Patient Financial Services teams, Finance teams at all URMC affiliate hospitals, and others in understanding hospital reimbursement and contracts. Responsible for special projects involving reimbursement and finance. Establishes and adheres to project timelines and activity plans. Assists in developing department policy/procedure.

Other duties as may be assigned.

Background Expectations:

Required:

1. Bachelor’s Degree and 5-7 years’ related work experience or equivalent combination of education and/or related experience

2. Proficient with Microsoft Office products, including MS-Excel and MS-Access

3. Minimum three (3) years’ experience in healthcare managed care and/or healthcare insurance provider contracting and/or medical or financial analysis or Revenue Cycle experience is required

4. Comprehensive understanding of healthcare terminology, insurance contract language and hospital/professional payment methodologies, including an understanding of Medicare and NYS Medicaid reimbursement

5. Strong analytical skills

6. Effective communication skills (both written and oral)

7. Ability to work in a team setting with all levels of management and staff

Preferred:

1. Master’s Degree in Public Health, Healthcare Administration, Accounting, Business Administration or related field.

2. Healthcare Revenue Cycle, Decision Support and Contract Management software (E.g. nThrive, Axiom/Syntellis, EPIC)

3. Basic SQL proficiency or aptitude to learn

4. Project Management experience

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $68,765 - $103,147 Annually

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

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Location: Health Sciences
Full/Part Time: Full-Time
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