Contracts Analyst - Cdm

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation's leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

 

We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Responsibilities

The Senior Contract Analyst, CDM will support Prime Healthcare's Contract Analytics and Revenue Integrity functions. The Senior Contract Analyst, CDM will also collaborate with other stakeholders and process owners to ensure that the contract analytics are scaled to support other operations such as Patient Access, CDM, RIT, HIM, Coding, PFS and Denial Management. The Senior Contract Analyst, CDM will set up and maintain the contract matrix and rate levels for all hospitals, support the implementation & maintenance of the Contract Management Tool, oversee the implementation & maintenance of the internal expected reimbursement tool and collaborate with the patient access department to optimize the front-end collections workflow. The Senior Contract Analyst, CDM will ensure compliance with CMS Price Transparency Rule of posting hospital's contracted reimbursement rates.

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Qualifications

EDUCATION, EXPERIENCE, TRAINING

Bachelor's degree in Healthcare Administration, Finance, or a related field of study is required

Minimum five (5) years of experience in healthcare contract analytics or related revenue cycle operations is preferred

Minimum two (2) years of experience in leading US Healthcare Contract Analytics Billing, Charging or Other Revenue Cycle Functions is required

Experience working with the Contract Management/Analytics Tool is preferred

Prior experience in adjudicating the claim is required

Experience working with payers including Medicare, Medicaid, and commercial insurance

Understanding of CPT's, HCPCs, Diagnosis code, DRG code, EAPG, revenue code, etc. is required

Understanding of payor payment methods viz.. Fee Schedule, RCC, Case rate is required

Prior experience working with EPIC and Meditech preferred

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law:  https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $64,480.00 to $97,760.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Type: FULL_TIME