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Payer Compliance Analyst

Weill Cornell Medical College

New York, NY
Weill Cornell Medical College
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Job Details

Position Summary

Maximizes managed care reimbursement by preparing data for contract negotiations, auditing claims to identify non\-compliance with contract terms and validating physician and fee schedules set up during contract implementation and amendment\. Analyzes payment data and to identify trends in payment errors and payment policies to increase reimbursement\. Compiles and analyzes membership and payment data as required to manage the contracts\. Works with managed care organization to resolve contract related issues\.

Job Responsibilities

+ Analyzes and audits a high volume of contracted managed care claims data to identify non\-compliance with contract terms and improper linkage of physicians to Weill Cornell fee schedule\.

+ Analyzes proposed reimbursement rates for potential contract against industry standards and internal criteria\.

+ Assists in providing training on processes and procedures to maximize reimbursement\.

+ Assists in validating and maintaining contracting terms, and contract coding and setup in Experian Contract Management module\.

+ Develops and maintains complex queries and reports that combine multiple sources of data\.

+ Identifies trends in payments errors and payment policies to increase reimbursement\.

+ Prepares monthly ad hoc reports on managed care contract compliance and recovery activities for PO physicians based on paid data from applying criteria from managed care plan payment policies and other industry standard criteria\.

+ Serves as a liaison with managed care organization representatives to facilitate the explanation or resolution of questionable claim adjudications based on plan EOBs or other documentation for WCPO and voluntary faculty who are in the IPA\.

+ Verifies accuracy of fee schedules for contracted managed care plans by product by geographic region and distributes fee schedule and information about specific codes to POBO, PO physicians and administrators and voluntary faculty\.


+ Bachelor's Degree in related field


Approximately 2 years of related work experience\.

Knowledge, Skills and Abilities

+ Proven analytical skills including the ability to analyze data from various sources and identify errors\.

+ dvanced knowledge of Microsoft Excel and Microsoft Access including the ability to create pivot tables, perform V\-lookups, manipulate data, create formulas to analyze information and import and export data between Excel and Access\.

+ Proficiency using Microsoft Word\.

+ Effective organizational and time management skills, including the ability to meet deadlines and function effectively in a high volume work environment\.

+ Good interpersonal skills, including the ability to interact effectively with various constituencies\.

Licenses and Certifications

Working Conditions/Physical Demands

Weill Cornell Medicine is a comprehensive academic medical center that's committed to excellence in patient care, scientific discovery, and the education of future physicians in New York City and around the world\. Our doctors and scientists\-faculty from Weill Cornell Medical College, Weill Cornell Graduate School of Medical Sciences, and the Weill Cornell Physician Organization\-are engaged in world\-class clinical care and cutting\-edge research that connect patients to the latest treatment innovations and prevention strategies\. Located in the heart of the Upper East Side's scientific corridor, Weill Cornell Medicine's powerful network of collaborators extends to its parent university Cornell University; to Qatar, where an international campus offers a U\.S\. medical degree; and to programs in Tanzania, Haiti, Brazil, Austria and Turkey\. Our medical practices serve communities throughout New York City, and our faculty provide comprehensive care at NewYork\-Presbyterian Hospital/Weill Cornell Medical Center, NewYork\-Presbyterian/Lower Manhattan Hospital, and NewYork\-Presbyterian/Queens\. At Weill Cornell Medicine, we work together to treat each individual, not just their conditions or illnesses, as we strive to deliver the finest possible care for our patients \- the center of everything we do\. Weill Cornell Medicine is an Equal Employment Opportunity/Minorities/Females/Vet/Disabled employer\.
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