Oregon Medical Group Payor Contract Analyst in Eugene, Oregon
Payor Contract Analyst
+ + Job Tracking ID: 512611-724241
Job Location: Eugene, OR
Job Type: Full-Time/Regular
Date Updated: November 25, 2020
- Starting Date: ASAP
Hours: Monday-Friday, 8 am-5 pm
Number of Openings: 1
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PURPOSE OF POSITION: By developing and analyzing the various special projects as directed by the CFO/CEO, the Financial Analyst is serving the entire Oregon Medical Group organization and the patients that it serves. This position is also responsible for developing, interpreting, and implementing complex financial and accounting concepts, or techniques for financial planning and control. Major responsibilities will include analysis and reporting of Physician Compensation, medical group payor contracting, monitoring and management of shared risk arrangements, assisting in budget development and review and interpretation of specialty department financial statements.
TYPICAL PHYSICAL DEMANDS: Requires sitting for long periods of time. Some bending, stooping and stretching required. Working under stress and use of telephone required. Occasional lifting of up to 25 pounds. Requires normal range of hearing and manual dexterity sufficient to operate computer keyboard, telephone, photocopier, calculator and other office equipment.
TYPICAL WORKING CONDITIONS: Normal office environment. Work may be stressful at times due to deadlines.
EXAMPLES OF DUTIES:
Proactively identify revenue generating opportunities or risks, researches and reports on payor market trends at the local and national level.
Routinely develop, review and analyze statistical, cost, and financial reports for complex payor contracts.
Verify payor rate schedule updates for compliance to contract terms. Educate and communicate payor methodology and/or rate changes to the appropriate OMG department staff.
Attend meetings with payors and other OMG departments as needed.
Support contract negotiations through review of contract language, modeling of proposed contract terms and rates and make recommendations as appropriate to CFO.
Prepare financial payor models and benchmark comparisons to support contractual decisions including assumptions, observations, conclusions and recommendations.
Monitor and evaluate quality metrics and risk arrangements on a quarterly basis to proactively identify areas for analysis and operational focus and improvement.
Perform testing on complex payor claims to ensure accuracy and compliance to contract terms.
Plan, develop and prepare complex reimbursement models, including but not limited to, clinically integrated networks, value based payment and reimbursement, population health management, risk and capitation for the purpose of determining payor contract proposed terms as compared to current contractual terms and other comparable payor contract terms.
Experience and Skills:
PERFORMANCE REQUIREMENTS: Comprehensive understanding of healthcare terminology, insurance contract language and professional payment methodologies, including a good understanding of Medicare and Medicaid reimbursement. Ability to communicate clearly and to effectively negotiate with health plan payors. Ability to effectively present information and respond to questions from payors. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to examine documents for accuracy and completeness. Ability to prepare reports in accordance with detailed instructions.
EDUCATION: Bachelor's degree from four-year College or university; or four to six years related experience and/or training; or equivalent combination of education and experience.
SKILLS: Microsoft Office Suite, Advanced Excel knowledge, Access database management, Contracts database management. Experience using sequel programming is a plus.
EXPERIENCE: Three years of experience working in healthcare finance/economics with healthcare insurance contracts and the payment methodologies associated with various services is required. Strong analytical, interpersonal and communication skills. Ability to work independently, interdependently with multiple teams. Good project management skills; ability to prioritize multiple projects in relation to the organization's strategic and tactical focus. Ability to work with interruptions and changing work priorities, and under tight deadlines.