Contract and Reimbursement Analyst

The Contract and Reimbursement Analyst will provide financial and analytical support for managed care contract negotiations and
reimbursement monitoring across all payers for - UT Health San Antonio ”. This role requires a deep understanding of physician
and facility reimbursement methodologies, the ability to analyze and synthesize large data sets, and a commitment to maintaining
the highest level of data integrity.

This position will report directly to the Director of Managed Care. The analyst is expected to collaborate internally within UTHSA
across various departments (e.g., finance, IT, revenue cycle, coding) as well as externally with managed care organizations

• Extensive knowledge of claims process, medical terminology and healthcare concepts, including knowledge of
  CPT/HCPCS, ICD-10, DRG coding and methodologies.
• Fundamental knowledge of managed care payment models as well as inpatient and outpatient reimbursement
  methodologies, such as MS-DRG, AP-DRG, per diems, case rates, RBRV’s and percentage discounts.
• Specific experience with commercial health plans, Texas Medicaid and Medicare reimbursement.
• Direct experience with management and maintenance of contract modeling platforms (preferably in Epic).
• Strong understanding of financial and accounting principles.
• Proficiency in word processing, spreadsheet, and database software.
• Ability to analyze complex problems, draw relevant conclusions, and implement comprehensive solutions.
• Excellent analytical and financial skills with an eye for detail and accuracy.
• Exceptional communication and interpersonal skills, with the ability to collaborate professionally outside the organization.

EXPERIENCE:

EDUCATION:

• Bachelors Degree Required in mathematics, statistics, business, finance, health care administration, or related field required. A combination of relevant education and experience may be considered.

CERTIFICATION/LICENSES:

• Resolute Hospital Billing Reimbursement Contracts Administration Certification: Completed within 180 days of Hire

• Load and maintain all available payer reimbursement schedules within Epic’s Hospital Base and Physician Base
  Contract Management module.
• Review, understand, and interpret new and existing managed care relationships/contracts, including: value based,
  shared savings and incentive programs, for negotiation, renegotiation, and termination (when appropriate).
• Quantify the impact of managed care contract proposals in Epic and provide thoughtful analysis to the leadership and
  other stakeholders.
• Review and modify adjustments to existing pricing models in Epic to increase the accuracy of projected reimbursement.
• Develop and analyze reports summarizing managed care payer performance and trends. Recommend adjustments to
  payer payment methodologies, contracted rates, or claim processing standards to improve the financial performance of
  MSRH.
• Identify trends in underpayments by modeling expected reimbursement to actual reimbursement and work collaboratively
  with payers and other internal stakeholders, as required.
• Work collaboratively with members of the revenue cycle and IT teams to support reimbursement variance monitoring
  tools in Epic, CDM updates, pre-visit patient financial estimates, mass payer appeals, general payer relations concerns,
  or other needs as identified.
• Maintain relationships and professionally collaborate with managed care payer representatives to improve managed care
  collections and positively resolve contract interpretation issues.
• Communicate contract issues and relevant updates to payer payment and/or claims processing methodologies to
  revenue cycle stakeholders.
• Work with finance staff to develop projections for the annual budget process.
• Assist with establishing, tracking, and maintaining letters of agreement (LOA), and single case agreements (SCA) with
  commercial, Medicaid, and Medicare health plans.
• Communicate managed care updates and content within the department and organization through internal systems,
  including but not limited to: SharePoint, website information, and newsletters.