Contract Compliance Analyst III

Exact Sciences • Madison, WI

34d • $51,000 - $84,000

About The Position

At Exact Sciences, we’re helping change how the world prevents, detects and guides treatment for cancer. We give patients and clinicians the clarity needed to make confident decisions when they matter most. Join our team to find a purpose-driven career, an inclusive culture, and robust benefits to support your life while you’re working to help others. Position Overview The Contract Compliance Analyst III will facilitate contract implementation and revenue pull-through activities, both proactive and reactive, with internal and external parties. This position will ensure the public and private payer reimbursement. The role is also fundamental in reviewing that billing and payment processes are efficient, timely, and in compliance with corporate goals, contracts and/or regulations. This position will facilitate and manage contract implementation for operations and partner with Managed Care to develop and maintain agreements that provide medical providers and patients with access to our assays while aligning with Exact Sciences goals and objectives.

Requirements

• 3+ years of experience in billing/reimbursement, coverage, claims, and appeals.
• Demonstrated understanding of public and private Managed Care payers and reimbursement process.
• Demonstrated understanding of market-related issues, contract basics, product coverage, and pull through rationale.
• Proficient with Excel and Epic or similar database; demonstrated ability to maintain competency levels.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
• Applicants must be currently authorized to work in country where work will be performed on a full or part-time basis.
• We are unable to sponsor or take over sponsorship of employment visas at this time.

Nice To Haves

• Knowledge of and/or experience with government Managed Care payers.
• Knowledge of billing and coding.

Responsibilities

• Develop communication for contracts, amendments, and notifications for the internal Revenue Cycle Team (RCT) customers and collaborate with the Field Managed Care team in negotiations with payers for operational optimization.
• Play a role in the development and maintenance of a contract database and contract management system, working with the credentialing and legal teams.
• Collaborate with finance and analytics to identify, analyze, and determine next steps to address negative revenue pull-through scenarios specific to payers and across payer segments; including Medicare Advantage, Blues, Medicaid, etc.
• Collaborate with RCT Managers and specialists to develop and leverage relationships with billing operations staff and payers when resolving claim adjudication issues, both contractual and non-contractual.
• Support execution of pull-through plans to meet quarterly/annual revenue recovery goals.
• Identify broad revenue opportunities that span a particular customer segment; including utilizing Content Management Systems (CMS) for noncontracted Managed Medicare non-payments and the Employer Coalition initiative.
• Consistently identify opportunities to recover revenue.
• Collaborate with the Managed Care team to identify and prioritize plan(s) utilizing key payers for targeted efforts to impact coverage policy decisions.
• Facilitate conversations with appropriate Exact personnel early in the contracting process to provide an overview of the account to avoid delay in implementation down the road.
• Strong attention to detail and organizational skills.
• Strong analytical skills.
• Ability to drive to results with a high emphasis on quality.
• Ability to present recommendations supported by analytical evaluations.
• Strong ability to prioritize and multi-task.
• Ability to integrate and apply feedback in a professional manner.
• Excellent communication, both written and verbal, across internal and external personnel.
• Ability to collaborate and work effectively as a team member.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the Quality Management System team’s policies and procedures.
• Maintain regular and reliable attendance.
• Ability to act with an inclusion mindset and model these behaviors for the organization.
• Ability to work designated schedule.
• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
• Ability to work on a computer and phone simultaneously.
• Ability to use a telephone through a headset.

Benefits

• Exact Sciences is proud to offer an employee experience that includes paid time off (including days for vacation, holidays, volunteering, and personal time), paid leave for parents and caregivers, a retirement savings plan, wellness support, and health benefits including medical, prescription drug, dental, and vision coverage.
• Learn more about our benefits .
• Our success relies on the experiences and perspectives of a diverse team, and Exact Sciences fosters a culture where all employees can develop personally and professionally with a sense of respect and belonging.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 501-1,000 employees