Job Description

The Payment Compliance & Contract Management (PCCM) Analyst is responsible for maximizing reimbursement by identifying variances between posted and expected revenue for managed care, government contracts, and other payers. This role includes analyzing contract compliance, identifying revenue opportunities, and communicating discrepancies to relevant departments. The PCCM Analyst collaborates with financial and clinical teams to improve revenue cycle processes and optimize payer relationships.

Essential Functions

• Analyzes contract reimbursement, identifying variances, trends in underpayments/overpayments, denials, and revenue leakage to support maximization of reimbursement.
• Manages underpayment appeals and account follow-up, working collaboratively with payers and internal teams to resolve discrepancies in a timely manner.
• Interprets contract terms, validates compliance, and provides feedback to management and departments to ensure accurate reimbursement processes.
• Compiles, analyzes, and presents data on payment trends, making recommendations for improvements in revenue cycle processes.
• Reviews payer policies and updates for their impact on reimbursement, communicating changes to appropriate teams to ensure compliance.
• Develops and maintains reports that identify payment discrepancies, revenue opportunities, and performance metrics for management review.
• Collaborates with financial, clinical, and operational teams to address contract compliance issues and enhance payer relations.
• Maintains knowledge of medical coding systems, reimbursement structures, and regulatory changes to support accurate account adjudication.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree or higher preferred
• 2-4 years of experience in revenue cycle management, contract compliance, or healthcare reimbursement analysis required

Knowledge, Skills and Abilities

• Strong understanding of managed care, government contracts, and reimbursement processes.
• Proficiency in data analysis, with the ability to compile and interpret complex data sets related to contract compliance and payment trends.
• Excellent communication and interpersonal skills for working with internal teams and external payer representatives.
• Knowledge of medical coding systems (ICD-10, CPT, HCPCS, DRG, etc.) and how they affect claim adjudication.
• Strong organizational skills, with the ability to manage multiple projects and deadlines.
• Proficient in Google and Microsoft Office Suite, with intermediate to advanced Excel skills.