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Sr Payer Compliance Analyst Job
Date: May 4, 2012
Location: INDEPENDENCE, OH, US
SR PAYER COMPL ANAL MC
Reference Title
HR Use Only: Sr Payer Compliance Analyst
Hospital: Cleveland Clinic Main Campus & Family Health Centers
Facility: INDEPENDENCE WEST CREEK MCO
Department: MANAGED CARE
Job Code: T28125
Pay Grade: 14
Schedule: Full Time
Shift: Days
Hours: 8am - 5 pm
Job Details: - Masters Degree Preferred
Summary: Makes recommendations regarding managed care payer compliance. Manages aspects of contract management systems and analyzes financial impact of compliance issues.
Job Responsibilities: Audits data integrity, accuracy, and reliability. Assists with contract negotiation and document preparation. Conducts appropriate audit processes using claims files and other data sources to assure payor compliance with implant, high cost drug, and other specialized contractual terms. Coordinates this effort with other Business Development staff, Patient Financial Services, Clinical Departments, and payor representatives, as appropriate. Interacts with payor representatives to resolve issues identified by audits. Transmits new contract documents to vendor, assures correct and consistent loading, provides contract interpretation, validates sample calculations on new contracts. Assists with the maintenance of historical and current compliance information by payor by product by entity in a contract database. Other duties as assigned.
Education: Bachelor's degree or equivalent experience required. Master's degree preferred
Experience: Minimum five years of patient financial and/or utilization analysis and reporting experience, preferably with some or all related to the managed care industry. Prior experience in a payor or provider environment. Experience in contract document review and reimbursement methodologies.
Licensure/Certification/Registration: None.
Physical Requirements: Manual dexterity to operate office equipment. Ability to lift and transport up to 15 pounds. May require extended periods of standing, walking or sitting. Good visual acuity through normal or corrected vision.
KEYWORDS: Insurance, Contracts, revenue analyst, CPC, CPC-P, CCS
Category: Finance/Information Systems
Reference Title
HR Use Only: Sr Payer Compliance Analyst
Hospital: Cleveland Clinic Main Campus & Family Health Centers
Facility: INDEPENDENCE WEST CREEK MCO
Department: MANAGED CARE
Job Code: T28125
Pay Grade: 14
Schedule: Full Time
Shift: Days
Hours: 8am - 5 pm
Job Details: - Masters Degree Preferred
Summary: Makes recommendations regarding managed care payer compliance. Manages aspects of contract management systems and analyzes financial impact of compliance issues.
Job Responsibilities: Audits data integrity, accuracy, and reliability. Assists with contract negotiation and document preparation. Conducts appropriate audit processes using claims files and other data sources to assure payor compliance with implant, high cost drug, and other specialized contractual terms. Coordinates this effort with other Business Development staff, Patient Financial Services, Clinical Departments, and payor representatives, as appropriate. Interacts with payor representatives to resolve issues identified by audits. Transmits new contract documents to vendor, assures correct and consistent loading, provides contract interpretation, validates sample calculations on new contracts. Assists with the maintenance of historical and current compliance information by payor by product by entity in a contract database. Other duties as assigned.
Education: Bachelor's degree or equivalent experience required. Master's degree preferred
Experience: Minimum five years of patient financial and/or utilization analysis and reporting experience, preferably with some or all related to the managed care industry. Prior experience in a payor or provider environment. Experience in contract document review and reimbursement methodologies.
Licensure/Certification/Registration: None.
Physical Requirements: Manual dexterity to operate office equipment. Ability to lift and transport up to 15 pounds. May require extended periods of standing, walking or sitting. Good visual acuity through normal or corrected vision.
KEYWORDS: Insurance, Contracts, revenue analyst, CPC, CPC-P, CCS
Category: Finance/Information Systems
Nearest Major Market: Cleveland
Job Segments: Business Development, Claims, Compliance, Contract Manager, Database, Facilities, Information Systems, Insurance, Legal, Operations, Sales, Technology
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