Payer Contracting Analyst

Payer Contracting Analyst

The Payer Contracting Analyst performs payer financial analysis, strategic pricing, and payer reimbursement modeling for all of CCRM’s Managed Care payer agreements. This strategic position will work directly with our Directors of Payer Strategy and National Managed Care to model any number of financial scenarios related to contract pricing/re-pricing and their associated impact on bottom-line financial metrics. Provides analysis findings to key business stakeholders.
CCRM is an industry-leading pioneer in fertility science, research and advancement, offering access to national network of award-winning physicians, a full suite of fertility services, innovation technology and cutting-edge labs. CCRM is currently comprised of over 33 locations spanning the U.S. and Canada with growth planned for continued network development on a domestic and international basis.  CCRM is proud to assist in building all kinds of families.

  • Perform strategic pricing analysis to support the negotiation and implementation of appropriate reimbursement between CCRM and payer networks. Develop financial models and evaluate payer performance in relation to contract(s).
  • Monitor contract financial performance. Create reports and dashboards evaluating payer performance and impacts on CCRM’s bottom-line.  Review and accurately interpret contract terms, including payer policies and procedures impacting contract performance.
  • Provide stakeholder training of the modeling of proposed/existing negotiated payer contracts, including expected and actual revenues/volumes, past performance, proposed contract language and regulatory changes.
  • Prepare analyses focusing on financial performance by payer group. Develop methods and models (involving multiple variables and assumptions) to identify the implications/ramifications/results of a wide variety of new/revised strategies, approaches, provision, parameters and rate structures aimed at establishing appropriate reimbursement levels.
  • Effectively prepare, maintain, monitor and present results to key stakeholders, for review and decision-making activities.
  • Maintain knowledge of operations sufficient to identify causative factors, deviations, allowances that may affect reporting findings. Ability to translate operational knowledge to identify unusual circumstances, trends or activity and project the related impact on a timely, pre-emptive basis.

Bachelors/Masters Degree in Computer Science, Finance, Accounting or a related field. Equivalent education and work experience will be considered.

Work Experience and Qualifications

  • Minimum of two years of experience in financial healthcare reimbursement analysis is required, including an understanding of national standards for fee-for-service and value-based provider reimbursement methodologies.
  • Experience in contribution to profitability through detailed financial analysis and efficient delivery of data management strategies supporting contract analysis, trend management, budgeting, forecasting, strategic planning, and healthcare operations.
  • Strong technical understanding of Excel.
  • Proficiency with SQL and the ability to pull data from a relational database is required.
  • Working knowledge of healthcare financial statements and accounting principles.
  • Ability to pull data and reports from multiple EMR systems
  • Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas.

Language Skills

  • Ability to read, analyze and interpret regulations and other documents.
  • Strong interpersonal skills and ability to effectively and tactfully present information to, and communicate with, co-workers, employees, and others.
  • Possess exceptional English written and verbal communication skills, including accurate grammar and business correspondence knowledge.
  • Ability to read and write memos, reports, and correspondence that conform to prescribed style and format.

Reasoning Ability

  • Ability to define problems, collects data, establish facts, and draw valid conclusions.

Other Skills and Abilities:

  • Able to establish and maintain cooperative and positive working relationships.
  • Organized, detail-oriented, diplomatic, proactive, self-motivated, dependable, and driven by excellence.
  • Even-tempered and able to balance multiple tasks in accordance with changing deadlines and priorities in a fast-paced environment.
  • Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds.
  • Other duties as identified

This is a full-time position based in Lone Tree, Colorado; remote or hybrid work arrangements may be available and/or required due to Covid or other events; local and national travel may be required. Normal hours include planning time, consultation with local and remote staff, travel time, and educational activities.
This job operates in a professional office.  This role routinely uses standard office equipment such as computers, including computer keyboards and mice; telephones; photocopiers; scanners; filing cabinets. Working evenings and weekends may be required occasionally to perform the tasks outlined in the job description.
While performing the duties of this job, the employee is regularly required to communicate with others. The employee is frequently required to sit; will occasionally stand and/or walk; use hands and fingers to grasp, pick, pinch, type; and reach with hands and arms. Employee is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; viewing a computer terminal; extensive reading; operation of standard office machines and equipment.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
CCRM is an equal opportunity employer and does not discriminate on the basis of Race, Color, Religion, Creed, National Origin, Ancestry, Sex, Pregnancy, Age, Sexual Orientation (including transgender status), Physical or Mental Disability, Marriage to a Co-Worker, or for anyone engaging in Protected Activity (opposing a discriminatory practice or participating in an employment discrimination proceeding). Additionally, this employer does not tolerate any employees engaging in discriminatory behavior based on any of the aforementioned protected classes.

All offers of employment by this employer are conditional upon the incumbent’s successful completion of pre-employment screenings, including a criminal background check, drug screen, educational and prior employment verification, professional reference checks, and verification of the incumbent’s eligibility and authorization to work in the United States.