Senior Contract Management Analyst

Job Family

Business Operations

Travel Required

Up to 10%

Clearance Required

None

What You Will Do

It is the responsibility of the Senior Contract Management Analyst to lead as the contract rate loading expert, by providing support to the team accountable for translating payer contractual terms into pertinent parameters loaded into the Contract Management Database, which produces the pricing of expected reimbursement. Monitors the contract inventory for accuracy of the expected reimbursement and proper reflection of net revenue. Oversees the cross referencing of payer insurance plan codes to associated payer contracts ensuring gaps are closed. Perform as principal specialist in rate modeling and analysis projects; will assist with preparing account dataset included in rate analysis, activate pricing of rate model, validate pricing results, and determine projected revenue impacts. Will preserve a skillset of the logic constructed within the Contract Management Database and will contribute to the overall health of the Contract Management tool by maintaining various functions. This position will perform all job-related duties as assigned.

Essential Job Functions

Self-reliant in loading/modeling rates within Contract Management SystemPrimary support resource for all analysts responsible to load and model contractsParticipate in the development and implementation of new rate methodology logicAudit the integrity of contracts loaded/modeled to ensure pricing is as expectedMonitor pricing performance of contracts loaded/modeled to quickly identify anomaliesContribute to creating and maintaining useful provision/contract templatesSupport the implementation of new rate modeling and analysis projectsContribute to the support of rate modeling Clients as directed by leadership

Duties And Responsibilities

Skillful in translating contractual terms and loading relevant parameters in Contract Management DatabasePerform Rate Modeling; activate pricing on account dataset, and validate resultsExtract key rate model details and format projected revenue impact analysis filesOrganize rate model documents in standard format on shared network drive(s)Participate in presentation of rate model analysis and strategy planning sessionsResearch and secure thorough understanding of new rate methodologies and participate in development and implementation Audits new and existing contract loads/models and provides feedback in set formatsIdentify and report problematic rate modeling functionality and recommend improvementRegular communication with Data Service Team to validate account datasets imported into Contract Management DatabaseContribute to providing ad hoc reports as requested from advisory and operational teamsAid with reviewing and resolving modeling inquiries from contract modeling teamParticipate in meetings with payment compliance teams focusing on issue resolution

Client Responsibility

Maintain confidentiality of all private health information and contractual termsComplete assigned responsibilities in a timely, accurate and thorough mannerReport conflicting terms within payer contracts subject to adverse effect on revenueProvide support as needed by hosting or attending project meetingsPerform all responsibilities and communication in a professional manner

What You Will Need

Bachelor’s degree required or high school diploma with additional year's experience7+ years’ experience in a Managed Care environment; Acute Hospital contract modeling/pricing

What Would Be Nice To Have

Sound familiarity with managed care payer contracts and product offeringsPossess effective/accurate oral and written English communication skillsCapable to identify contractual terms subject to multiple interpretations Accustomed to an organized project structure that affords successful proactive outcomesKnowledge of Microsoft Word, Access, and strength within ExcelFamiliarity with concepts of database management and EDI processesGeneral knowledge of hospital-based patient accounting and contract management systems preferredWide-ranging knowledge of medical coding methodologies including Rev Code, ICD-10, CPT, HCPCS, MS DRG, APR DRG, ASC, EAPG and APCUnderstanding of medical billing procedures and forms including UB-04 and HCFA-1500Comprehensive knowledge of medical reimbursement methodologies including per diem, case rates, DRG rates, ASC rates, APC rates, fee schedules, EAPG rates, APR DRG rates, Stop loss provisions and Carve-outsWorking knowledge of medical terminology

The annual salary range for this position is $87,100.00-$130,700.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits Include

Medical, Rx, Dental & Vision InsurancePersonal and Family Sick Time & Company Paid HolidaysPosition may be eligible for a discretionary variable incentive bonusParental Leave401(k) Retirement PlanBasic Life & Supplemental LifeHealth Savings Account, Dental/Vision & Dependent Care Flexible Spending AccountsShort-Term & Long-Term DisabilityTuition Reimbursement, Personal Development & Learning OpportunitiesSkills Development & CertificationsEmployee Referral ProgramCorporate Sponsored Events & Community OutreachEmergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.