Associate

We need to hire 2 associates in Contracts AI team for new sites transition. Required FTEs are 8 however we have 6, short by 2.

Below is Job description for role:

The “Contracts Analyst” will be responsible for (Creating, maintaining, and analyzing Expected Reimbursement values and Variances). This person will (strive for Contract Excellence and become a Subject Matter Expert in various payment methodologies including Commercial, Government and State specific logic).
In this role, the successful candidate will work with various Internal and External team members both on and offshore to identify risk areas and seek opportunities for increased accuracy. The successful candidate must have demonstrated ability to read Payor Contract language, provide previous experience in Healthcare or Revenue Cycle management, and demonstrate the passion to lead the team to success.

ABOUT THE ROLE:

We are looking for a Payor Contract Analyst to join the Contract Modeling division of our Rules and Contracts team. This team is primarily responsible for developing, analyzing, and maintaining contract models in Cloudmed’s new proprietary contract modeling engine, Cloudmed AI™. As a Payor Contract Analyst, you will develop expertise in payor contract structures and contract modeling, resolve continuous improvement requests from project teams, and collaborate with team members on new initiatives in a rapidly growing environment with tight deadlines.

WHAT YOU WILL DO (Including, but not limited to...)

• Review and interpret payor contracts to identify all relevant information influencing reimbursement rates and terms.
• Create and updates contracts in tools based on agreement done between insurance and hospitals.
• Need to create fee schedules and other reimbursement methodologies.
• Need to analyze contracts expected reimbursement and maintain accuracy and payor plan coverage.
• Enter all terms and details of contract into proprietary software tools to execute pricing.
• Design, analyze and maintain healthcare reimbursement models to ensure revenue is in line with the contracts.
• Analyze contract modeling engine results to validate reimbursement rates and terms that have been built and configured correctly relative to client data and other inputs.
• Report/highlight the exceptions or trends in reimbursement methods.
• Effectively communicate the findings with recommendations to project team.
• Develop deep expertise in payor contract modeling.
• Other related duties as assigned.

WHAT YOU WILL NEED:

• Preferably graduate degree in Statistics / Mathematics / Economics / Commerce / Finance from a reputed educational institute
• General understanding of US healthcare payors, billing, coding.
• Good analytical, organizational and time management skills.
• Skills to read, understand and interpret reimbursement contracts between hospitals and insurance providers.
• Strong computer skills with emphasis on Microsoft Excel, Microsoft Access
• Good communication skills (both written & verbal);
• Preferably 1-3 years of experience in US healthcare.
• Self-starter who is eager to learn and can work both independently and in a team environment.

Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.

Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit: r1rcm.com

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