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Springfield Clinic Senior Contract Analyst (Managed Care) in Springfield, Illinois

The Senior Contract Analyst position is a dynamic, highly visible, multifunctional role with inter-departmental interaction. This person is responsible for assisting with the financial and administrative oversight of payer relations and contracting with payers on behalf of Springfield Clinic. Works closely with Director of Managed Care to oversee the validation of insurance reimbursement in alignment with contractual terms. Collaborates with the Clinic’s Business Information Analytics and Information Management teams to provide impactful reporting and create actionable dashboards. Identifies areas for opportunity with payers in terms of reimbursement and assists in developing the strategy to realize these opportunities. In addition, the Senior Contract Analyst will assist in contract negotiations through advanced contract modeling applications. Ensures internal support is provided so that contracting needs are thoroughly understood and helps with developing a strategy for achieving while enhancing revenue and patient access, and providing general assistance and backup support to the Director of Managed Care.

Job Relationships

Reports to the Director of Managed Care.

Principal Responsibilities

  • Oversee the building, testing, and maintenance of payer contracts utilizing the Clinic’s Payer Contract Management platform.

  • Facilitate problem solving of operational issues through collaboration with Managed Care team and other internal stakeholders.

  • Complete advanced financial analysis and modeling of patient claims utilizing current contract modeling systems in place to include the following:

  • Perform scenario analysis of Payer reimbursement using patient claims data and contract terms; analyze impact of counter and final proposals.

  • Assist in developing summary presentation of rate proposal for executive leadership with rationale and recommended options.

  • Prepare contract payment terms for the Clinic’s Payer Contract Management Platform and validate correct coding for all completed contracts.

  • Develop payer statistic report cards through the creation of dashboard analytics.

  • Collaborate with the Director of Managed Care to support payer relations business needs.

  • Work with payers as needed to ensure proper understanding of payer’s guidelines, contractual terms, and the processing of Springfield Clinic claims.

  • Collaborate with patient accounting and compliance colleagues to resolve improper reimbursement.

  • Maintain all associated documentation for all payer and third party contracts.

  • Provide administrative coordination and oversight of payer contracts in accordance with contract goals, objectives, and activities.

  • Provide applicable payer reporting.

  • Analyze and coordinate execution of single case agreements and requested contracts including communications with other teams.

  • Strict confidentiality is required.

  • Comply with the Springfield Clinic incident reporting policy and procedures.

  • Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.

  • Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.

  • Perform other job duties as assigned.

Education/Experience

  • Bachelor’s degree in business, healthcare administration, data analytics or other related field is required.

  • Minimum two years’ experience with health care analytics, accounting, contracting or other related area is required.

Knowledge, Skills and Abilities

  • Strong relationship management skills

  • Strong analytical and critical thinking skills as well as verbal and written communication skills are required.

  • Ability to produce reports and analyze data is required.

  • Ability to work independently is required.

  • Microsoft Office experience is required.

Working Environment

  • Most of the time will be spent in the office, with occasional travel possible.

  • This job operates in a professional office environment. Routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

PHI/Privacy Level

HIPAA1

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