Payor and Contract Reimbursement Analyst

Job Description:

The Contract and Reimbursement Analyst will provide financial and analytical support for managed care contract negotiations and reimbursement monitoring across all payers for the UT Health San Antonio Multispecialty and Research Hospital (MSRH). This role requires a deep understanding of hospital reimbursement methodologies, the ability to analyze and synthesize large data sets, and a commitment to maintaining the highest level of data integrity. This position will report directly to the MSRH Director of Revenue Cycle. The analyst is expected to collaborate internally within UTHSA across various departments (e.g., finance, IT, revenue cycle, coding) as well as externally with managed care organizations.

Responsibilities

• Load and maintain all available payer reimbursement schedules within Epic’s HB Contract Management module.
• Review, understand, and interpret new and existing managed care relationships/contracts, including: value based, shared savings and incentive programs, for negotiation, renegotiation, and termination (when appropriate).
• Quantify the impact of managed care contract proposals in Epic and provide thoughtful analysis to the leadership and other stakeholders.
• Review and modify adjustments to existing pricing models in Epic to increase the accuracy of projected reimbursement.
• Develop and analyze reports summarizing managed care payer performance and trends.
• Recommend adjustments to payer payment methodologies, contracted rates, or claim processing standards to improve the financial performance of MSRH.
• Identify trends in underpayments by modeling expected reimbursement to actual reimbursement and work collaboratively with payers and other internal stakeholders, as required.
• Work collaboratively with members of the revenue cycle and IT teams to support reimbursement variance monitoring tools in Epic, CDM updates, pre-visit patient financial estimates, mass payer appeals, general payer relations concerns, or other needs as identified.
• Maintain relationships and professionally collaborate with managed care payer representatives to improve managed care collections and positively resolve contract interpretation issues.
• Communicate contract issues and relevant updates to payer payment and/or claims processing methodologies to revenue cycle stakeholders.
• Work with finance staff to develop projections for the annual budget process.
• Establish, track, and maintain letters of agreement (LOA), and single case agreements (SCA) with commercial, Medicaid, and Medicare health plans.
• Assist with payer setup process, education on new and existing payer relationships and coordinates administrative access duties for: Rev. Cycle, department staff to appropriate web portals, and web dashboard related payer tools.
• Communicate managed care updates and content within the department and organization through internal systems, including but not limited to: SharePoint, website information, and newsletters.

Qualifications

• Extensive knowledge of claims process, medical terminology and healthcare concepts, including knowledge of CPT/HCPCS, ICD-10, DRG coding and methodologies.
• Fundamental knowledge of managed care payment models as well as inpatient and outpatient reimbursement methodologies, such as MS-DRG, AP-DRG, per diems, case rates, RBRV’s and percentage discounts.
• Specific experience with Texas Medicaid reimbursement
• Direct experience with management and maintenance of contract modeling platforms (preferably in Epic).
• Strong understanding of financial and accounting principles.
• Proficiency in word processing, spreadsheet, and database software.
• Ability to analyze complex problems, draw relevant conclusions, and implement comprehensive solutions.
• Excellent analytical and financial skills with an eye for detail and accuracy.
• Exceptional communication and interpersonal skills, with the ability to collaborate professionally outside the organization.

Required Skills

• Five (5) years of related experience with reimbursement modeling and contract management.

About Us

Benefits Overview

UT Health San Antonio offers an excellent benefits package for its employees. Employees who work at least 20 hours a week, with an appointment of at least 4.5 months, are eligible for benefits.
Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas. Family members can be added to the plan through payroll deduction. Employees and their dependents can also receive discounted copays and coinsurance when using UT Health Physicians, a network of 800 premier physicians including more than 100 specialists.
Dental - Three dental insurance plan options are available for employees and their families through Delta Dental Insurance Company, two PPOs and one dental HMO plan. Both PPO plans allow employees to choose any licensed dentist.
Vision - Fully insured Vision Care benefits are offered by Superior Vision Services. Two vision plan options that offer either standard or enhanced vision benefits. Life Employees receive $40,000 of group term life insurance and $40,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates.
Retirement - Employees are eligible for either the Teacher Retirement System (TRS) or the Optional Retirement Plan (ORP). TRS is a defined benefit retirement plan which UT Health matches employee contributions. ORP is for eligible faculty staff employees. Voluntary retirement programs are also available to invest before- or after-tax dollars with the choice of five quality retirement plan providers.
Time Off - A generous leave program offers multiple paid leave options:

• Front-loaded Paid Time Off: 128 to 208 hours (16 to 26 days) of Paid Time Off based on years of service, given at the start of each fiscal year. PTO may be prorated in year one based on date of hire.
• Extended Illness Bank: 8 hours (1 day) accrued per month which can be used for illness or injury after one day of Paid Time Off is taken.
• Paid Family Leave: Up to 240 hours (6 weeks) to care for a spouse, child, or parent after 6 months of consecutive employment.
• Holidays: 12 set paid holidays each year.

FSAs - Employees can enroll in flexible spending accounts (FSAs) to set aside money from earnings before taxes for qualifying dependent day care expenses or out-of-pocket health care expenses.
Discounts - Employees enjoy a range of discounts on services, tickets, and gym membership.
EEO Statement

UT Health San Antonio is an equal employment opportunity and affirmative action employer. It is our policy to promote and ensure equal employment opportunity for all individuals without regard to race, color, religion, sex, gender identity, national origin, age, sexual orientation, disability, or veteran status.