Contract Resolution Specialist

CoxHealth

1d • Remote

About The Position

The Contract Resolution Specialist primary function will be to assist network providers with any contractual issues. The Contract Resolution Specialist will also act as a trainer/educator of all CoxHealth Network contracts to the network providers and their staff. They must be a self-starter and work with minimal supervision. Some local travel is required along with organizing and hosting meetings when required. They will possess an in-depth working knowledge of managed care plans and CoxHealth contracts and how they pertain to successful operations of a hospital/provider’s office. The responsibility of this position impacts the revenue cycle for approximately 40% of the provider’s business. They must understand the legality of the messenger process CoxHealth Network uses for independent providers. They must be able to analyze and communicate contractual terms and their requirements to the provider. They will perform initial and recredentialing on-site reviews and chart audits for providers, as needed. Responsibilities include, but are not limited to; contract resolution, delivery and interpretation of policy and procedure changes as it relates to specific contracts, communication of regulatory changes as it relates to the insurance industry as needed, researching new technology with respect to payors medical necessity and coverage, Maintains contacts and provides educational information to network, tertiary/affiliate PHO networks that impact over 3000 providers/facilities. Able to organize, prioritize and multi-task to execute projects and day to day work flow.

Requirements

• High School Diploma or Equivalent
• 3-5 Years experience working in the provider office, healthcare billing, healthcare insurance and/or Managed Care industry
• Ability to understand complex multi-provider payor contract agreements and determine compliance standards are being adhered to.

Nice To Haves

• Bachelors in a Related Field
• Previous experience in provider relations and/or physicians office management

Responsibilities

• contract resolution
• delivery and interpretation of policy and procedure changes as it relates to specific contracts
• communication of regulatory changes as it relates to the insurance industry as needed
• researching new technology with respect to payors medical necessity and coverage
• Maintains contacts and provides educational information to network, tertiary/affiliate PHO networks that impact over 3000 providers/facilities
• Able to organize, prioritize and multi-task to execute projects and day to day work flow

Benefits

• Medical
• Vision
• Dental
• Retirement Plan with employer match

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED