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Department

Job Summary

Under the general supervision of the Contract Payer Manager, this role is responsible for overseeing and managing commercial and Medicare Advantage payor contracts and integration of Epic systems. This position serves in a provider relations capacity for both internal and external stakeholders. The Payer Contracting Financial Analyst works closely with the Revenue Cycle (including Hospital Physician Business Services, Coding, Patient Access, Reimbursement and other related departments), Finance department and external commercial insurance payor representatives. This position collaborates internally and externally to understand and improve provider data, provider configuration, claims denials, operational issues and payor contractual requirements.

Essential Functions:

• Ensures the payor contracting department possesses relevant knowledge of commercial and Medicare Advantage payor enrollment requirements and develops and maintains provider rosters issues and a mechanism for resolving enrollment issues. (35%)
• Collaborates with Medical Staff Office to collect and submit accurate information for the provider directories; updates, audits and sends provider rosters to commercial payers in compliance with payor standards. (20%)
• Develops strong relationships with internal and external customers and serves as a liaison between payors and internal departments such as Revenue Cycle, Registration, Patient Access and Medical Staff Office to resolve issues related to provider roster issues, contracting, billing, payments and registration. (20%)
• Conducts financial analyst and cost comparison for payor contract negotiations. Negotiates single case agreements to capture financial reimbursement from non-contracted entities. Supports Payor Contracting Director in contract negotiations. (15%)
• Responsible for facility credentialing (5%)
• Completes other assigned special projects and research. (5%)

Education:

• Bachelor's Degree Required or
• High School Diploma or GED and 7-10 years of experience in contract management, provider relations or provider enrollment in lieu of bachelor's degree. Required

Work Experience:

• 7-9 years in provider relations, payor contracting, provider enrollment, payor configuration or provider-facility credentialing Required

Licenses:

• EPICPA-EPIC Provider Administrator - DHHA - Denver Health and Hospital Authority

Knowledge, Skills and Abilities:

• Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills. Strong ability to articulate complex issues to broad audience.
• Strong knowledge of commercial and Managed Medicare contracts is required. Understanding of provider data fields open/closed panel, taxonomy, hospital based, PCP, Specialist, provider directories as well as services line and CPT procedures.
• Working knowledge of billing, reimbursement and general revenue cycle management strategies.
• Excellent organizational skills, detail oriented and have a strong ability to multi-task.
• Utilizes software applications and working knowledge of the following information systems to include accessing information, updating, correcting and/ or deleting data. General knowledge related to various software applications and their capabilities. Microsoft Office applications: Word, Excel, PowerPoint and Outlook and other applications as needed.
• Ability to independently define problems and develop relative solutions, collect data, establish facts, and draw valid conclusions.

Shift

Work Type

Salary

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future - with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development - while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays

• 100% paid parental leave up to 6 weeks

• Immediate eligibility for retirement plans with employer contribution up to 9.5%

• Generous medical, dental, vision plans in addition to employer paid disability and life insurance.

• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center

• Free RTD EcoPass (public transportation)

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.

As Colorado’s primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.

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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.Denver Health is an Equal Opportunity Employer At Denver Health we pride ourselves on our commitment to diversity. Equal opportunity is a fundamental principle of Denver Health. As an equal opportunity employer, Denver Health is committed to recruit, hire, promote and administer all human resource actions in a non-discriminatory manner. Denver Health is committed to providing equal opportunities in all business practices and to all persons regardless of age, race, color, national origin, genetic information, religion, sex, pregnancy, disab...ility, sexual orientation, gender identity, gender expression, marital status or veteran status (collectively “protected status”). Denver Health strives to maintain a work environment that is free from unlawful harassment and discrimination and will not tolerate any such conduct by employees or directed at employees within the scope of their employment. Read the full Human Resources Employee Principles and Practices policy.

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