Utah Retirement Systems

Provider Relations Analyst I

US-UT-Salt Lake City
2 weeks ago(1/5/2018 1:13 PM)
Job ID
2018-2490
Category
Provider Relations
Min
USD $23.33/Hr.
Max
USD $29.16/Hr.

About The Company

A division of Utah Retirement Systems, PEHP is a non-profit trust with the vital job of providing health benefits to Utah’s public employees and their families.

Job Description

POSITION SUMMARY

Performs a variety of professional duties related to and in support of, PEHP provider panel development and contracting, provider relations, reimbursement data analysis, benefit planning, and future organizational development.

 

ESSENTIAL JOB FUNCTIONS AND DUTIES

  1. Responsible for the ongoing negotiation and development of network / provider contracts and relationships of the PEHP provider network.  
  2. Performs analysis of reimbursement structures/data, based on information from internal and external sources. Including unique fee schedules through various payment methodologies.
  3. Develops and prepares reports, data summaries, etc. through close and effective working relationships with PEHP support staff. Ensures reports are accurate, complete and are distributed in a timely manner to the appropriate personnel.
  4. Prepares annual physician and hospital reimbursement renewal analysis of provider fee schedules.
  5. Creates annual fee schedules for providers using various reimbursement methodologies including RBRVS and DRG reimbursement models.
  6. Responsible for managing risk through analysis and maintaining Provider Relations Manuals for both internal and external sources.
  7. Performs updates on policies and development of PEHP Provider Network in conjunction with the Provider Relations Director. 
  8. Analyzes and researches complex issues related to PEHP providers and develops alternative solutions within the framework of established guidelines and legal regulations; designs and recommends changes to programs, contracts, policies and procedures. Recommends and prices alternate plan network design options as necessary for existing and prospective groups.
  9. Serves as a representative and liaison between provider organizations and PEHP. Apprises provider of contract specifics related to calculation of payments, fee schedules, hospital and facility discounts, schedule of benefits, coordination of benefits, etc.
  10. Directs development of preferred provider membership criteria and supports screening of applicants.
  11. Monitors utilization patterns and evaluates physician and hospital usage.
  12. Serves as a backup to the Provider Relations Data Specialist for all fee schedule entering responsibilities.
  13. Compiles data to be used by PEHP in developing future managed care systems. Tracks historical trends and projections in utilization and health care costs.
  14. Assists with the dental provider network including development and management of fee schedules.
  15. Maintains strict confidentiality.
  16. Performs other related duties as required.

Required Experience

Education and Experience

Bachelor’s degree required.  Preference will be given to  bachelor degrees in the following fields of study: health care, business, math, statistics or related field; plus, five (5) years working experience with either an insurer or medical provider (physician, hospital, etc.), which includes at least two (2) years of experience in data analysis or an equivalent combination of education and experience.

 

Knowledge, Skills, and Abilities

This list contains knowledge, skills, and abilities that are typically associated with the job. It is not all-inclusive and may vary from position to position:

 

Required technical skills include the working knowledge and ability of:

  • Health care information systems.
  • Microsoft Office Suite, with proficiency in Excel.
  • Draft technical reports, documents and agreements.

 

 

Required mathematical skills include working knowledge of:

  • Finance of managed care.
  • Practical statistical knowledge.
  • Basic bookkeeping.

Required working knowledge of:

  • Healthcare coding.
  • Various medical, dental, and pharmacy claims adjudication policies, procedures, and processes.
  • Intricacies related to medical, dental, mental health and chiropractic claims.
  • Basic public relations.
  • Various health, dental and alternative care delivery systems.
  • Health care laws.

Must possess excellent communication skills:

  • Communicate to providers the abstract economic principles relative to PEHP’s payment vision.
  • Organizational communications.
  • Interpersonal communications.
  • Negotiation techniques.
  • Training methods.
  • Communicate effectively both verbally and in writing.
  • Technical writing.

Must have the ability to:

  • Coordinate varied operational functions and activities.
  • Analyze a variety of health care issues and make recommendations.
  • Follow written and verbal instructions.
  • Prioritize work.
  • Perform within deadlines.
  • Work well in a team environment as well as independently.
  • Maintain effective working relationships with professionals, executives, department heads, co-workers and the public.
  • Multi-task by handling a variety of duties in a timely and efficient manner.
  • Manage multiple projects simultaneously.
  • Analyst difficult situations, problems, and data.
  • Use sound judgment in decision making and problem solving.
  • Follow through with assignments.
  • Deal effectively with stress caused by workload and time deadlines.

 

The incumbent must always demonstrate judgment, high integrity, and personal values consistent with the values of URS.

 

Work Environment

Incumbent performs in a typical office setting with appropriate climate controls. Tasks require a variety of physical activities which do not generally involve muscular strain, but do require activities related to walking, standing, stooping, sitting, reaching, talking, hearing and seeing. Common eye, hand, finger dexterity required to perform essential functions.

 

Job duties require occasional travel for office business. Individual must be physically capable of safely operating a vehicle, possess a valid license and have an acceptable driving record based upon data provided by a current Department of Motor Vehicle Record (MVR).

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed