Contract Management Analyst, Full Time - Days

Be a part of a world-class academic healthcare system, UChicago Medicine, as a Contract Management Analyst with the Rev Cycle Department. This is a Flexible remote, opportunity and will be required to come onsite.

The Contract Management Analyst is responsible for building all third-party payer contract reimbursement terms (contract profiles) including but not limited to Managed Care Commercial payers, Government programs (Medicare, IL Medicaid), Medicare Advantage payers and Medicaid payers into UCM contract management systems and calculating expected reimbursement at the claim level (hospital) and line level (Physician). The Analyst will be responsible for updating and maintaining the accuracy of contract profile builds in the contract management systems and will develop variance reports that analyze expected reimbursement to actual payment to determine internal issues or payer compliance payment variances. The variance reports shall also ensure consistent expected reimbursement results across contract management systems and root cause and adjust as needed. The Analyst shall serve as a managed care subject matter expert for hospital and physician contract rate methodology and reimbursement terms and will, as needed, run analyses to understand historical trends and future performance of existing contracts. Assists OMC VP and Directors in payer contract negotiations as requested and applicable, particularly with review of potential reimbursement methodologies and their feasibility to be built in the contract management system. Assists Revenue Cycle management teams in review of payment variances and underpayment recoveries.

Essential Functions

• Responsible for all payer contract profile builds including calculation of expected reimbursement terms in all FFS contracts and contract rate model builds for system hospitals and physicians in any contract management system. Leads ongoing maintenance and auditing of contract management rate calculations to check for variances to expected contract terms.
• Works with OMC and Revenue Cycle teams on variance analysis of contract profile outputs to current payments. Based on review of models and audits for variance, works with these parties and payers on underpay opportunities and payment issues stemming from non-compliance with contract terms.
• Create reports of contract outputs, historical trends, and variance analyses as needed for OMC, revenue cycle, and senior leadership .
• Review payer contract proposal terms, in conjunction with OMC leaders, for accuracy and implementation feasibility.

• Continued education on ever-changing reimbursement rules and policy updates both commercial and governmental that impact expected reimbursement and contract profiles and education of internal stakeholders on reimbursement terms, methodology and impacts as needed

Required Qualifications

• A Bachelor’s degree in Business, Finance, Healthcare, or related field, or a combination of relevant education and experience.

• Five or more years of experience in a multi-facility health system in either: Finance operations like managed care (preferred), cost accounting planning, or budget

• Revenue cycle operations such as billing, collections, or payment processing

• Requires detailed knowledge of hospital and physician complex reimbursement methodologies, particularly fee for service commercial contracts as well as Medicare and Medicaid. Value based care (VBC) risk reimbursement structure knowledge preferred but not required.

• Excellent understanding of contract language and rate terms, physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws. Examples include:

• Proficient understanding of MS-DRG, APC, EAPG, case rate, stoploss, carveout reimbursement methodologies

• Proficient understanding of Revenue Code and CPT coding in a clinical/hospital/ASC/physician office setting

• Proficient manage care contract rate interpretation skills

• Experience with payer compliance review including underpayment variances and denial management highly desirable.

• Not Mandatory:

  Preferred certification in Epic Resolute Expected Reimbursement Contracts Administration and NThrive Contract Management system

  If candidate does not have at least one of these certifications, candidate has 6 months to complete and pass as part of their probationary period.

Position Details:

• Job Type/FTE: Full Time (1.0 FTE)
• Shift: Days, Monday-Friday
• Unit/Department: Revenue Cycle
• Work Location: Flexible Remote (will need to be onsite as needed)
• CBA Code: Non-Union