As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

• University of Utah Health Plans is committed to transforming health care through innovative initiatives, new provider payment methodologies, thoughtful network analysis and the development of ACOs dedicated to improving the customer experience, increasing quality and reducing costs. Under the direction of the UUHP Provider Contracting Manager, the Contract Reimbursement Analyst is responsible for analyzing and developing recommendations for provider reimbursement as well as network configuration.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

• Provides accurate and timely pre- and post-contract negotiation analysis.
• Prepares market analysis including population demographics, provider cost and quality data, and network configuration for optimal network adequacy ratios for all lines of business by service area.
• Develops and performs financial analysis of reimbursement methodologies and terms for all contract types including, but not limited to, hospital, home health, SNF, DME, lab, LTAC, RTC, and physician.
• Works with contract negotiator to develop negotiation scenarios, including preparing what-if scenarios.
• Reviews and audits contract terms within 90 days of implementation to ensure accuracy and compliance.
• Acts as the designated liaison for providers and other internal departments regarding payment accuracy.
• Prepares and monitors Key Performance Indicators (KPIs) for contracts (i.e., top 10 volume, expense).
• Develops and disseminates provider dashboards.

Knowledge / Skills / Abilities

• Strong analytical and problem-solving skills.

• Strong oral and written communication skills.

• Demonstrated excellent database/modeling skills.

• Extensive knowledge of provider contract analysis.

• Industry knowledge of healthcare provider reimbursement methodologies including but not limited to capitation, FFS, per diem, case rate, stop loss, % of billed charges, RVUs, etc.

• Working knowledge of various healthcare codes such as HCPCS, CPT, DRG, ICD, revenue and others.

Qualifications

Required

• Bachelor's degree in Actuarial Science, Business, Economics, Finance, Mathematics or equivalent healthcare related experience with knowledge of provider contracting analysis/modeling.
• Four years of experience in similar position.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.