Contracts Analyst

Prime Healthcare Management Inc•Ontario, CA

48d•$25 - $28

About The Position

Prime Healthcare is seeking a Contracts Analyst to originate and maintain physician and provider contract packets and Letters of Agreement (LOAs) for its self-funded medical plan (EPO). The role tracks contract submissions and approvals, maintains and updates contact files, and amends contracts as appropriate. It requires responsibility, confidentiality, judgment, and discretion when applying department policies and handling confidential information. The Contracts Analyst communicates with physicians and vendors, helps expand the provider network, recommends solutions to management for providers who are lacking or contracted within the Prime network, and performs special projects assigned by the Corporate Director of Employee Health (EPO).

Requirements

High school graduate or GED.
Working knowledge of the physician credentialing process and strong follow-up skills.
Knowledge of CPT and ICD-10 codes, Medicare guidelines, and Managed Care contracts.
Working knowledge of self-funded medical plans and/or Managed Care plans.
Computer literacy in Microsoft Office Windows.
Ability to interact professionally with physicians and vendors.

Nice To Haves

Associate's degree from an accredited institution.

Responsibilities

Originate and maintain physician and provider contract packets and Letters of Agreement (LOAs).
Track contract submission and approval processes.
Maintain and update contact files.
Amend contracts as appropriate for the self-funded medical plan (EPO).
Communicate effectively in writing, verbally, and by telephone.
Expand the provider network.
Recommend to management action regarding lacking or contracted providers within the Prime network.
Perform special projects as assigned by the Corporate Director of Employee Health (EPO).
Apply department policies and procedures with responsibility, confidentiality, judgment, and discretion when handling confidential information.