The Senior Payer Contract Compliance Analyst is responsible for the activities related to the Contract Management system (Harvest), and collection and coordination of information for the Patient Financial Services and the Managed Care Contracting team. They will oversee the daily reconciliation, maintenance (i.e., contract terms, conditions, rates, and mapping), and reporting of the Contract Management system.Â In addition, will review/monitor payer billing policies, produce data to support various initiatives, including but not limited to identifying payer and claim related issues, developing financial analyses and supporting the Managed Care Department and PFS claims management team at routine payer meetings
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to underserved members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.
PRIMARY DUTIES AND RESPONSIBILITIES:
Monitor Contract Management System
Ensure accurate, complete, and timely data reconciliation within the Contract Management system (Harvest)
Update contract rates/terms, updating plan mapping, and confirm accuracy of underpay/overpay results
Review, interpret, and document payer billing policies
Direct vendor in making programming changes based on changes to payer policies, terms and conditions
Monitor compliance with reimbursement terms by understanding DFCI contract terms and payer policies
Assist in oversight of the relationship between the Contract Management vendor (MedAssets) and DFCI
Assist in defining and evaluating the necessary and â€œnice to haveâ€� requirements of the Contract Management system, ensuring that the vendor can meet these requirements or in evaluating alternative systems
Payer Performance Reporting and Analytics
Ensure delivery of reporting and analyses to the Managed Care Department
Monitor payer compliance with reimbursement terms; analyze, track, and communicate impact of underpayments and/or overpayments
Identify payer and claim related issues, developing financial analyses, document trends, etc.
Participate in the developing solutions for identified payer payment issues
Prepare payer performance summaries and participate in meetings with payers and contract negotiations
Prepare complex analyses, executive summaries, and initiative reviews as needed: appropriately use Harvest to query claims data and perform analyses
Identify and investigate trends related to charges and reimbursement. May require root-cause analysis and working with non-revenue cycle areas to understand operational workflow and charging processes
Work with Managed Care, Patient Accounting, Revenue Integrity and Financial Planning to report specific findings and provide recommendations.
Performs other similar and related duties as required or directed
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:
Advanced knowledge of MS Excel, MS Word, MS Access
Knowledge of hospital billing and hospital revenue cycle including payer payment methodologies
Ability to function independently in a fast-paced environment while managing multiple priorities
Ability to recognize opportunities for innovation in reporting and work product
Ability to participate in continuous learning and development activities
Ability to apply the practice of learning and teaching others and apply that knowledge broadly
Ability to understand customer needs and meet timeline and product expectations
Superior interpersonal and communication skills to effectively work and communicate with all levels of internal and external staff
Advanced ability to demonstrate a customer service approach with internal and external clients
MINIMUM JOB QUALIFICATIONS:
Bachelorâ€™s degree in Accounting, Finance, Health Policy, Data Analytics, Management or related field; Masterâ€™s degree preferred
5 years of related managed care/contracting or claims management experience. Experience within the healthcare industry preferred
Experience with Epic and Harvest strongly preferred
Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other groups as protected by law.
Internal Number: 2020-20062
About Dana-Farber Cancer Institute
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute brings together world renowned clinicians, innovative researchers and dedicated professionals, allies in the common mission of conquering cancer, HIV/AIDS and related diseases. Combining extremely talented people with the best technologies in a genuinely positive environment, we provide compassionate and comprehensive care to patients of all ages; we conduct research that advances treatment; we educate tomorrow's physician/researchers; we reach out to under-served members of our community; and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.