Partners with Provider Relations and Contracting leadership to support contracting strategies and evaluation of the network for adequacy. This includes detailed analysis of cost, utilization, claims data review, performance, viable contract arrangements and recommendation explanations. The Analyst will apply problem solving and analytical skills to sustain current business models and implementation of process improvement opportunities. Analyst ensures quality controls are in alignment with the of provider recruitment and, Join the Network initiatives.
* Accesses financial impact of proposed contracts and One Time Agreement rates, across all lines of business. (Commercial, Medicare, Medicaid/CHP+).* Ensures accuracy of pre and post contract load and payment accuracy Participates and performs special project tasks as required. Assists in the development and implementation of applicable tracking and monitoring tools.* Produce ad hoc reports upon request* Updates and maintains contract templates * Collaborate with the Provider Relations and Contracting Manager to execute contracts, amendments, and renewals for the plan, ensuring all contracts, amendments and renewals meet regulatory requirements issued by the Center of Medicare and Medicaid Services ("CMS") and CO Department of Health Care, Policy & Financing ("HCPF").* Assists with testing of new benefit designs, Medicare and Medicaid fee schedules, RBRV fee Schedules, Procedure Code Sets, and ICD-9 Diagnosis Code Sets for configuration.* Other duties as assigned.
Knowledge, Skills and Abilities
* Demonstrates ownership and accountability* Research and strong problem-solving skills* Ability to collect and analyze data documenting appropriately * Comprehension of issues and alternate solutions * Ability to work independently and collaboratively* Strong analysis, contracting and negotiating skills are required. * Experienced in all aspects of contractual activities, including negotiating and reviewing legal, regulatory, operational, financials. * Intermediate financial analysis skills are required. * Must be capable to communicate effectively, verbally and in-writing, and manage multiple priorities and projects. * Able to effectively present complex information to all levels of individuals. * Commitment to key tasks and meeting deadlines. * Knowledge of CPT, ICD-9 and 10, DRG, HCPCS, RBRVS, bundled payments, risk-sharing, and provider capitation is essential. * Knowledge of claims processing is desirable. * Knowledge of Medicare, Medicaid, and commercial fee-for-service schedules, and industry regulations issued by the Center of Medicare and Medicaid Services ("CMS") and CO Department of Health Care, Policy & Financing ("HCPF") regulations is required.Computers and Technology* Proficient with Microsoft Excel, Access, PowerPoint, and claims adjudication systems. * Experience and proficiency with Trizetto QNXT is highly desired.
Education & Experience
A Bachelor's degree in healthcare, business administration, is required.* Seven years of experience in analyzing, negotiating, and executing healthcare contracts with a wide variety of providers and healthcare institutions required.* Two years of experience analyzing and drafting Medicaid, Medicare, and Commercial contracts, including fee-for- service, bundled payments, risk-sharing and capitation, is required. * Progressive experience in healthcare insurance provider relations and contracting preferred.
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver's 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.
As Colorado's primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.
Located just south of downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
"Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class."
Internal Number: 2472
About Denver Health
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation’s leaders in medicine.