Job Family:

Business Operations

Travel Required:

Up to 10%

Clearance Required:

None

What You Will Do:

It is the responsibility of the Senior Contract Management Analyst to lead as the contract rate loading expert, by providing support to the team accountable for translating payer contractual terms into pertinent parameters loaded into the Contract Management Database, which produces the pricing of expected reimbursement.  Monitors the contract inventory for accuracy of the expected reimbursement and proper reflection of net revenue.  Oversees the cross referencing of payer insurance plan codes to associated payer contracts ensuring gaps are closed.  Perform as principal specialist in rate modeling and analysis projects; will assist with preparing account dataset included in rate analysis, activate pricing of rate model, validate pricing results, and determine projected revenue impacts.  Will preserve a skillset of the logic constructed within the Contract Management Database and will contribute to the overall health of the Contract Management tool by maintaining various functions.  This position will perform all job-related duties as assigned. 

Essential Job Functions

• Self-reliant in loading/modeling rates within Contract Management System

• Primary support resource for all analysts responsible to load and model contracts

• Participate in the development and implementation of new rate methodology logic

• Audit the integrity of contracts loaded/modeled to ensure pricing is as expected

• Monitor pricing performance of contracts loaded/modeled to quickly identify anomalies

• Contribute to creating and maintaining useful provision/contract templates

• Support the implementation of new rate modeling and analysis projects

• Contribute to the support of rate modeling Clients as directed by leadership

Duties and Responsibilities

• Skillful in translating contractual terms and loading relevant parameters in Contract Management Database

• Perform Rate Modeling; activate pricing on account dataset, and validate results

• Extract key rate model details and format projected revenue impact analysis files

• Organize rate model documents in standard format on shared network drive(s)

• Participate in presentation of rate model analysis and strategy planning sessions

• Research and secure thorough understanding of new rate methodologies and participate in development and implementation 

• Audits new and existing contract loads/models and provides feedback in set formats

• Identify and report problematic rate modeling functionality and recommend improvement

• Regular communication with Data Service Team to validate account datasets imported into Contract Management Database

• Contribute to providing ad hoc reports as requested from advisory and operational teams

• Aid with reviewing and resolving modeling inquiries from contract modeling team

• Participate in meetings with payment compliance teams focusing on issue resolution

Client Responsibility

• Maintain confidentiality of all private health information and contractual terms

• Complete assigned responsibilities in a timely, accurate and thorough manner

• Report conflicting terms within payer contracts subject to adverse effect on revenue

• Provide support as needed by hosting or attending project meetings

• Perform all responsibilities and communication in a professional manner

What You Will Need:

• Bachelor’s degree required or high school diploma with 10 years' experience in contract management/modeling

• 6+ years’ experience in contract management/modeling

• Knowledge of Microsoft Word, Access, and strengths within Excel (pivot tables)

What Would Be Nice To Have:

• Managed Care environment; Acute Hospital contract modeling/pricing

• Sound familiarity with managed care payer contracts and product offerings

• Possess effective/accurate oral and written English communication skills

• Capable to identify contractual terms subject to multiple interpretations 

• Accustomed to an organized project structure that affords successful proactive outcomes

• Familiarity with concepts of database management and EDI processes

• General knowledge of hospital-based patient accounting and contract management systems preferred

• Wide-ranging knowledge of medical coding methodologies including Rev Code, ICD-10, CPT, HCPCS, MS DRG, APR DRG, ASC, EAPG and APC

• Understanding of medical billing procedures and forms including UB-04 and HCFA-1500

• Comprehensive knowledge of medical reimbursement methodologies including per diem, case rates, DRG rates, ASC rates, APC rates, fee schedules, EAPG rates, APR DRG rates, Stop loss provisions and Carve-outs

• Working knowledge of medical terminology

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The annual salary range for this position is $75,800.00-$113,600.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected]. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.