Associate

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 Cloudmeds 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