Contract System Management Analyst

Option Care Health•Lincoln, NE

3d•$46,070 - $76,768

About The Position

Responsible for preparing third party payer agreements to load in the pharmacy management system for Option Care. Responsible for building the third party payer agreements in the pharmacy operations system (CPR Plus). Research, understand, and interpret the applicable billing rules, billing units, and terms and conditions of the agreement in order to drive success in billing and collecting on the services provided by Option Care. Supports the Managers and Directors within the Commercial Contracting group facilitating a cross functional and collaborative working relationship with Contracting, Pricing, Trade, and Revenue Cycle Management. Collaborate closely with the Contract Operations Department, as well as Revenue Cycle Management and the CMCs.

Requirements

Bachelor’s degree, or High School Diploma with at least 5 years of experience in Revenue Cycle Management, Contract Management, Home Infusion intake, or home infusion pharmacy technician.
Ability to work in a deadline driven environment
Strong analytical and problem solving skills
Ability to function individually as well as in cross-functional teams.
Ability to identify improvement and growth opportunities
Advanced level skill in Microsoft Excel with an ability to do VLOOKUP up, basic formulas, and pivot table work.
Experience with analyzing and reporting data ability to identify issues, model trends, or exceptions to drive improvement of results and find solutions
Experience with HCPCS coding, and Drug Pricing Sources (AWP, ASP, WAC)
Intermediate level skill in Microsoft PowerPoint and Microsoft Word
Willing to travel up to 10% of the time for business purposes (within state and out of state)

Nice To Haves

CPR Plus experience
Contract Management experience
Experience with Medicare, Medicaid, PBM, and other third party payer payment guidelines

Responsibilities

Create and build the record for third party payer contract agreements. This includes creating insurance plans, researching and inputting business rules, and loading the contract pricing terms for implementation
Maintain assigned payer agreements. Update and execute any changes to pricing, coding, or business rules.
Responsible for working with the Contracting and Revenue Cycle Management on site integration to insure proper insurance plans are accounted for, and assigned to the correct location
Identify contracts that are not generating revenue to see if there is an opportunity to purge records and reduce insurance plan selection errors
Audit third party agreement pricing tables to ensure accuracy to improve Revenue Cycle Management success
Collaborate with Pricing team when trends are identified to insure proper insurance plan was utilized so that we are maximizing profitability by reducing bad debt and other payer adjustments
Collaborate with IT and Revenue Cycle Management on System Upgrades that could impact contract build, as well as make recommendations on system enhancement opportunities
Collaborate with Revenue Cycle Management to insure proper insurance plans are set up, and able to be utilized by CMC
Provide detailed advanced system reports for revenue cycle management and pricing teams as it relates to payer pricing strategies that are being input into the system
Assist with training of Contract System Management Specialists