Job Description

The Contract Management/CDM Analyst is responsible for managing contract lifecycles, regulatory compliance, and clinical research operations. Skilled in reviewing, negotiating, and administering contracts while ensuring adherence to organizational policies and industry regulations. Adept at analyzing data tracking contract performance, preparing reports, and improving workflows and securing revenue.

Essential Responsibilities:

Perform a wide range of high-level and detailed analytical functions for contract management and negotiation, including but not limited to financial performance, reimbursement comparisons, risk analyses, and quality program assessments.

· Create and communicate complex financial and risk models for the purpose of evaluating historical and future performance of existing contracts

· Develop and produce financial reports on a periodic and ad hoc basis for hospital management

· Assist in negotiating contracts, maintaining contract management software, analyzing financial impact, and monitoring payments for compliance

· Support the managed care division’s initiatives through analysis and perform forecasts on the impact of reimbursement terms during contract negotiation process

· Assist in the preparation, processing, research, and analysis of Medicare, Medicaid, Commercial, and Managed care cost reports to ensure the accuracy of claim payments

· Review of all contracts to determine appropriate application of rates, provisions, and terms

· Interact with various hospital stakeholders, department heads, and physicians to educate staff related to managed care reimbursement models

· Work with departments to develop and maintain specific payment arrangements for unique services

· Collaborate with CFO and Revenue Cycle Director to develop contract language

· Identify potential underpayment trends through comparison of managed care contracts to actual reimbursement information via contract management technology

· Investigate third-party payer policies and contracts to verify accuracy of underpayment variances according to published payer guidelines

· Provide documentation for third-party payer audits

· Provide reimbursement information and analysis to other hospital departments and maintain knowledge of reimbursement regulations

· Adding, updating, or deleting charge codes, prices, and descriptions within the hospital billing system

· Reviewing the CDM to ensure it adheres to Medicare, Medicaid, and other industry billing and coding guidelines

· Maintains the chargemaster by incorporating new charges/services identified by departments, third-party changes, special requirements and coding updates

· Conducts annual reviews of the chargemaster to identify codes that have been deleted, added or replaced and ensures required updates to code descriptions

· Ensures organization wide compliance to federal, state and local regulations as well as governmental and commercial payer guidelines related to charge codes and chargemaster

· Audits chargemaster changes, maintains a detailed trail of these changes and communicates any change to all applicable departments

· Participates in third-party charge audits with other dedicated teams and assists in inquiries related to chargemaster

· Investigates CPT codes, revenue codes and other issues and resolves disputes within a stipulated time frame

· Supports clinical units in charge capture, coding accuracy and revenue management

· Performs related duties such as cost accounting, cost management, volume analysis functions and special projects as necessary

Knowledge, Skills, Abilities

· Work requires analytical skills to collect information from diverse sources, apply professional principles in performing various analyses, and summarize information and data in order to solve problems

· Broad understanding of computer system concepts and database relationships

· Good working knowledge of data management software applications, with ability to create reports from data available in various systems to satisfy the needs of senior management

· Ability to assess situations from a global perspective—determining the impact to the institution, department, and individuals involved—and implement changes

· Thorough knowledge and understanding of hospital financial operations, including the revenue cycle/reimbursement process

· Proficiency with Microsoft Excel

· Experience interpreting and displaying data for diverse audiences

· Ability to work effectively in a team environment

· Strong investigative, analytical, organizational, and critical thinking skills

· Excellent written and verbal communication skills

· Ability to prioritize multiple demands and work independently with minimal supervision

· Demonstrated knowledge of coding systems, including ICD, CPT and HCPCS codes

· Knowledge of industry pricing standards and third-party reimbursement policies

· Ability to stay apprised of healthcare regulatory and compliance requirements, particularly in regard to Medicare, Medicaid, and commercial payors

Education and Experience Required:

· EPIC Contract Certification in Hospital billing is required

· Bachelor’s degree in business administration, accounting, statistics, finance, or closely related field desired

· Minimum of five years of data or financial analytical experience required

· Experience working with cross-functional departments to research and resolve issues using innovative solutions preferred

Work Shift :

Day Shift (United States of America)

Scheduled Weekly Hours :

40