Sr. Contracts Analyst - Managed Care

Phoenix Children’s Hospital is the only specialty children’s hospital in Arizona and it is poised to become one of the foremost pediatric hospitals in the nation. The hospital is home to the state’s largest group of pediatric specialists and sub-specialists. In addition, the hospital continues to evolve its clinical practices and is working with leading local and national research partners to uncover new breakthroughs in pediatric medicine. PCH is a growing, thriving organization where opportunities for personal development and promotion of our employees will continue in years to come. PRIMARY PURPOSE:Creates and maintains systems and models using a variety of decision analysis tools, including DSM Contract Manager, to perform complex financial analysis, predictive modeling, contract compliance monitoring, and actual versus expected payment variance analysis. Ensures contract financial terms are accurately and optimally loaded in DSM Contract Manager and provides comprehensive financial reports for contract negotiations and business analysis. Daily responsibilities include the following (and additional duties as required): Acts as primary facilitator/support for Contract Management module of DSM System. Develops and maintains DSM contract management module. Ensures new contracts and contract updates are loaded in an accurate and timely fashion. Maintains integrity of system data. Tracks and verifies system data and load parameters. Prepares and distributes required reports on a timely basis to ensure maximum utilization of DSM contract management capabilities. Researches and resolves contract management system configuration issues to ensure accurate contract loading. Handles contract load issues with heal Assesses ability to implement complex financial reimbursement models. Prepares and submits contract load briefs for complex arrangements and fee schedules. Identifies potential load issues and recommends corrections. Performs financial modeling of contracts for “what ifâ€� scenarios. Takes a lead role in developing rate proposals for negotiations and communicating financial terms with payors. Interacts with payors to gain a thorough understanding of payor-specific coding, reimbursement system logic, and payment hierarchies. Communicates hospital modeling logic to payors for reconciliation of variances in modeled reimbursement. Conducts special studies to analyze variances between actual and expected revenue by payor. Completes back-end audits on selected services/payors. Makes recommendations for optimizing reimbursement. Develops and maintains DSM contract management module. Ensures accuracy of data and distributes required reports on a timely basis to ensure maximum utilization of DSM capabilities. Participates in special studies and/or projects involving financial analysis of payor reimbursement. Prepares reports of findings and makes recommendations as appropriate.  MINIMUM QUALIFICATIONS: Bachelor’s degree in Business, Information Technology, Finance, Accounting, Health Care Administration, or closely related field, or equivalent combination of post-secondary education and experience. Five (5) years hospital reimbursement experience working with managed care contracts and compliance terms. Three (3) years managed care contract system support experience in a health insurance or managed care setting. PREFERRED QUALIFICATIONS: Experience with Eclipsys applications, including SDSM system and Crystal report writing. Experience with hospital registration and billing systems. Experience with managed care principles, business models, and facility billing. Experience with DRG, CPT, and HCPCS codes and standard reimbursement payment methodologies. Experience with financial analysis and predictive modeling for sensitivity analysis. Experience with Microsoft Office applications. Job Title: Sr. Contracts Analyst - Managed Care Location: Phoenix, AZ 85016 Status: Full Time, Employee Reference ID: 001HU When you join us, you'll enjoy great benefits: Relocation Assistance Tuition Reimbursement Paid Time Off 401(k) Employee Assistance Program Medical/Dental/Vision/Life/Disability/Pet Insurance Flexible Spending Accounts Child Care Discounts Computer Discounts Fitness Center Discounts To learn how you can make a difference in a child's life or to apply online, visit our web site at www.PhoenixChildrens.com/employment