Payer Contract Analyst - Hybrid

WHO WE ARE:

AC3 was founded by a group of oncologists who built solutions to optimize their own practices. Now, we give specialty health practices the power to make decisions with better data. Our mission is to help them thrive through people, purposeful technology, and collaboration. The work we do empowers healthcare practitioners and their teams to provide the highest quality of care in a sustainable way. That’s what motivates us.

We’re looking for passionate, driven innovators to join our mission. If you thrive on challenge, love taking action, and get up every day ready to make a difference, apply now. Learn more at www.ac3health.com

COMPANY MISSION: To help specialty practices thrive.

POSITION SUMMARY: Responsible for interpreting and analyzing payer contract terms & reimbursement methodologies. This includes interpretating payer contract language to create & maintain accurate fee schedules, identify discrepancies between contracted terms and reimbursements. Actively analyzes data and actual reimbursements across clients and contracts to find opportunities for our clients to maximize reimbursements through payer negotiations, payer projects, identifying payer trends that are impacting client revenue, and payer analysis reports.

Essential Function and Job Responsibilities

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Review, interpret, extract, and organize key information from payer contracts/amendments into the Payer Contract Matrix.
• Create, maintain, and validate fee schedules according to contract payment sources and reimbursement rates.
• Analyze reimbursement data utilizing reports and AC3 solutions to identify discrepancies, payer trends, and client opportunities for maximum reimbursement.
• Research and review of payer contract documentation and payer website resources [i.e. provider manual, billing policies], to ensure contract compliance and integrity of payer reimbursement.
• Effectively communicate identified opportunities and trends supported with data, internally and externally.
• Compile reporting for correlating RCM team members to review unfavorable claim outcomes, potentially pursue recovery of underpayments, or submit corrected claims.
• Perform initial contact with payers to validate contracted rate discrepancies.
• Collaborate with AC3 Account Teams to ensure any fee schedule errors are quickly resolved, new codes are loaded, and payers are mapped.
• Collaborate with product and technology teams to contribute to the development of new technology solutions or enhancement of existing solutions and software.
• Compile client-facing standard reports and special projects pertaining to contracts, fee schedules, that are in alignment with company branding and templates. Reports may include but are not limited to; Charge Master Analysis, Quarterly Payer Scorecard Reports, Claim Analysis Reports, Underbilling Alerts.

POSITION REQUIREMENTS

• Bachelor’s degree in healthcare administration, Business Administration, or similar program preferred, or equivalent professional experience in contract management, denial management, or revenue cycle management.
• Industry Certification a plus [CSPR, CRCR, CHAM, CHFP, FHFMA, FACHE]
• Knowledge of and experience with various practice billing software systems; language, flow of work, processes, and billing procedures.
• Understanding of clinic, provider groups, and hospital revenue cycle and insurance payment methodologies.
• Deep knowledge and experience in payer contracts, insurance types, and associated billing and reimbursement policies.
• Strong communication skills and problem-solving ability
• Strong analytical, project planning and organizational skills
• Ability to handle payer contract, fee schedule, and analysis responsibilities for numerous clients simultaneously.
• Initiative and persistence to seek out and further knowledge of evolving billing practices and relaying to team to help foster industry expertise.
• Knowledge of state, federal, & commercial payer reimbursement rules, policies, & methodologies.

Why Work at AC3?

When you become an AC3 Team member, you can expect ongoing training, support, and a work culture like no other. We offer our Full-Time Team Members medical, dental and vision health and wellness benefits, along with employer paid life insurance, long and short-term disability policies. Because our team’s health and wellness are our priority, we start new hires off with an above average paid time out plan and offer a comprehensive wellness program, including onsite biometrics and ongoing mental and physical wellness support. We also provide all Team Members with access to company sponsored financial wellness counselors, employee assistance services and the opportunity to enroll in our company-matched, 401k plan. Come join our Winning Team!