Contracts Analyst

Option Care Health•Bannockburn, IL

19h•$62,386 - $104,000•Remote

About The Position

Manage implementation of assigned payer agreements for managed care, pharmacy benefit administrators, IPA, and other third-party payers for Option Care Health. Handle day to day issues that may arise out of existing contractual relationships with payers. Assist with reimbursement issues arising from contracts for medical and pharmacy billing. Assist managing department e-mail for all internal payer issues escalated by revenue cycle management, intake, operations, and sales. Complete assigned credentialing requests, provider information forms, and attestations for pharmacy locations and licensed individual practitioners.

Requirements

Knowledge of local, state, federal, and other regulations; knowledge of regulations and legal requirements governing the industry.
Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position.
Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.
Experience providing customer service to internal and external customers, including meeting quality standards for services.
Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates.
Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office, Word and Excel.
Ability to work on a personal or laptop computer for extended periods of time.
Willing to travel up to 10% of the time for business purposes (within state and out of state).

Nice To Haves

Bachelor's degree preferred.
At least two (2) years of experience of payer credentialing.
At least two (2) years of experience through patient registration or revenue cycle management.

Responsibilities

Implements third -party payer agreements for managed care, pharmacy benefit administrators, and other accounts for Option Care Health.
Creates and distributes contract implementation materials with appropriate internal customers to ensure claims billing systems are set up correctly, and communication of plan specifics are sent to field for instruction and reference.
Presents contractual updates on internal implementation calls.
Resolves issues related to contractual arrangements including, but not limited to: contract participation, fee schedules, basic contract terms, benefit type (medical, pharmacy, specialty pharmacy), medical claim denials, and pharmacy claim rejections.
Assists managing the department e-mail for all internal payer issues escalated by revenue cycle management, intake, operations, and sales.
Completes assigned credentialing requests, provider information forms, enrollment forms, and attestations for pharmacy locations and licensed individual practitioners.
Manages communication with assigned accounts as it relates to demographic changes to Option Care Health facilities.
Reviews published information for key payers for updates to the impacted locations.
Identifies, assesses, and communicates impact of potential changes or changes related to new state or federal legislation to impacted care management centers.
Maintains successful working relationships with internal departments such as Operations, Legal, Sales, and any other departments that are involved with or impacted by third-party payer contracts.
Attends client meetings where appropriate and in collaboration with Market Access or Contracting team members.
Participate in regional meetings as directed by management.
Assists with ad hoc projects, requests, and initiatives as assigned by management.