Do you consider yourself a great negotiator while displaying the Mercy Touch? If so, look no further!!
This exciting position is Monday through Friday with some travel involved with some days in the office and other days remote
One must live 75 miles or less from Mercy Medical Center's Main Campus
Work Shift
Day
Scheduled Weekly Hours
40
Summary
This position supports Mercy’s philosophy of patient centered care by having responsibility for the strategic management, negotiation, and financial evaluation of Workers’ Compensation contracts with insurance carriers, third-party administrators (TPAs), employers, and governmental entities. This role ensures contractual compliance, financial viability, and optimization of reimbursement while supporting organizational goals related to revenue integrity, regulatory compliance, and employer relations.
This position will also have Insurance Specialist duties of claims processing from pre-registration, obtaining authorization, billing insurance and the patient, and providing timely follow-up on billing issues and denials.
Job Description
Contracts and Financial Analyst
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Leads the negotiation, drafting, and execution of Workers’ Compensation contracts with carriers, TPAs, employers, and other stakeholders.
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Evaluates contract terms including fee schedules, reimbursement methodologies, carve-outs, escalation clauses, and payment timelines.
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Ensures all contracts comply with applicable state Workers’ Compensation statutes, fee schedules, and regulations.
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Maintains executed agreements and payment commitment documentation within designated contract management systems.
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Performs detailed financial analyses of Workers’ Compensation contracts, including reimbursement modeling, margin analysis, and underpayment trends.
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Assess financial performance against contracted rates and identify variance, denial, and underpayment risks.
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Prepares financial summaries and executive-level reports to support decision-making.
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Presents findings and recommendations to revenue cycle leadership.
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Oversees the Workers’ Compensation billing and reimbursement lifecycle, ensuring claims are billed accurately and paid according to contract terms.
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Serves as a subject matter expert on Workers’ Compensation reimbursement, state fee schedules, and regulatory changes.
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Monitors legislative, regulatory, and market changes impacting Workers’ Compensation and employer-based reimbursement.
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Manages disputes, appeals, and escalations with carriers, employers, and state agencies as needed.
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Monitors expiring credentials and facilitate timely renewals.
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Collaborates with finance, revenue integrity, compliance, legal, clinical, and operational teams to ensure alignment across the organization.
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Acts as a liaison between internal stakeholders and external payers or employers regarding contractual and financial matters.
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Provides guidance and education related to Workers’ Compensation reimbursement structures and contract interpretation.
Insurance Specialist
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Understands and interprets insurance, pre-authorizations, and the specific requirements per insurance payer.
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Performs pre-registration duties requiring good knowledge of hospital programs and procedures.
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Initiates an accurate and complete registration and makes required edits on these registrations.
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Verifies insurance coverage of hospital and clinic patients.
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Interacts effectively with physicians, physician office staff, patients, and families on a frequent basis.
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Uses the call manager and computer to perform all pre-registration duties.
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Possesses a complete understanding of the health insurance industry’s requirement for preauthorization per insurance payer.
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Implements and coordinates all functions relating to preauthorization of hospital services.
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Understands ICD-10/CPT coding systems for local medical review policies (LMRP), national coverage determination (NCD) and preauthorization process requirements.
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Bills hospital UB-04 claims and professional CMS-1500 forms.
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Assists the Insurance payers in resolving billing concerns as indicated.
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Processes third party insurance claims as assigned and follows up according to departmental guidelines to ensure timely payment of account balances.
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Uses the Epic system to bill claims, scrub claims and work payer rejections.
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Updates demographic and insurance information to the billing system as appropriate.
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Maintains work queues according to procedure, clearly defining the next actions and follow-up on all accounts.
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Documents all conversations and actions taken into the proper systems.
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Reviews insurance claims for completeness and accuracy prior to filing or mailing.
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Responsible for billing processes related to Worker’s Compensation cases.
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Follows up on underpayments to ensure complete payment is received.
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Effectively handle disputes with the state
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Ensures receipt of payment agreement letters and store them in the practice management system.
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Follows Mercy's safety guidelines, carries out job-specific safety duties and responsibilities, and promptly reports any unsafe conditions, situations, incidents, and injuries.
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Other duties as assigned.
Knowledge, Skills, and Abilities
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Advanced knowledge of Workers’ Compensation reimbursement methodologies and state fee schedules.
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Strong financial acumen with the ability to analyze complex data and identify revenue optimization opportunities.
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Demonstrated contract negotiation and drafting skills.
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Ability to translate technical contract and reimbursement details into clear financial narratives.
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Strong presentation skills with experience communicating to executive and financial leadership audiences.
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Proficiency in Microsoft Excel and other financial analysis or data visualization tools.
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Knowledge of hospital billing forms (UB-04, CMS-1500) and revenue cycle workflows.
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Familiarity with Epic or comparable healthcare information systems preferred.
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Advanced analytical, negotiation, and communication skills, with the ability to translate complex contractual and reimbursement structures into actionable financial insights for senior leadership.
Professional Experience
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5 years of progressively responsible experience required in:
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Workers’ Compensation contracting, reimbursement, revenue cycle management, or
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Healthcare payer contracting with demonstrated Workers’ Compensation expertise.
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Proven experience conducting financial analysis related to payer contracts and reimbursement performance required.
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Experience working directly with insurance carriers, TPAs, employers, or governmental agencies required.
Education
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Bachelor’s degree in Healthcare Administration, Finance, Business Administration, Accounting, or a related field required.
Licensure, Certification, Registration
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Certified Revenue Cycle Representative (CRCR) to be obtained within 6 months of employment.
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Certified Healthcare Financial Professional (CHFP) to be obtained within 6 months of employment.
Pay Rate Type
Hourly
Mercy is an independent, community-based organization supporting the Cedar Rapids area for over 120 years.
Mercy is an equal-opportunity employer. We value diversity, equity, and inclusion and therefore evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status, and other legally protected characteristics.
