Analyst- Payor Contracting and Credentialing

Oklahoma Heart Hospital • Oklahoma City, OK

73d

About The Position

Join Our Team at Oklahoma Heart Hospital (OHH). ONE TEAM. ALL HEART. At OHH, we believe that patient care is truly at the heart of everything we do. Our dedicated team members are involved in every step of our patients' journeys, bringing hope, compassion, and healing to both patients and their families. Together with our physicians and caregivers, we're shaping the future of heart care in Oklahoma by serving the state and leading the nation.

Requirements

• Bachelor's degree preferred; minimum of three (3) years progressive experience in healthcare setting may be substituted for degree.
• Three (3) years of experience in a medical billing office, with two (2) years of managed care and/or credentialing experience.
• Professional verbal and written communication skills.
• Medical terminology and medical insurance knowledge required.
• Knowledge of managed care/insurance contracts.
• Knowledge of business office procedures.
• Proven organization skills needed.
• Knowledge of health care industry.
• Excellent Customer Service background.

Responsibilities

• Serve as the primary contact for all Managed Care, Commercial, Medicaid, Tricare and Medicare contracting and credentialing functions for both hospitals and employed physicians/mid-level practitioners.
• Coordinate interaction with payors, group employers, and network representatives to accurately administer managed Care/Governmental Payor contract terms.
• Assist in resolution of problems associated with contractual and credentialing matters.
• Troubleshoot and provide support to the Contracting and Compliance Officer, Revenue Cycle Group, Medical Staff and OHHP Credentialing Team.
• Proactively identify revenue generating opportunities or risks, research and report on payor market trends at the local and national level.
• Develop, review and analyze statistical, cost, and financial reports for complex payor contracts.
• Data mine provider and payor financial and operational data for analysis.
• Perform testing on complex payor claims to ensure accuracy and compliance to contract terms.
• Verify payor rate schedule updates for compliance to contract terms.
• Complete all hospital, physician and mid-level provider credentialing with government, commercial, and managed care payors.

Benefits

• Medical, Dental, and Vision coverage
• 401(k) plan with employer match
• Long-term and short-term disability
• Employee Assistance Programs (EAP)
• Paid Time Off (PTO)
• Extended Medical Benefits (EMB)
• Opportunities for continuing education and professional growth

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees