Managed Care Contract Analyst - FT - Weekend Days (74874)

Hamilton Health Care System • Dalton, GA

2d

About The Position

This position is responsible for the overall management of payer contracts and the systems used to model, review, assess performance and negotiate contracts for Vitruvian Health. Working with the Director of Managed Care Contracting, provide support in the negotiation and review of payer contracts through data extraction and development of complex reimbursement modeling and interfacing with outside vendors and consultants as needed. Identifies and assists with revenue cycle reimbursement issues, identifies trends in payer payment practices and communicates with stakeholders. Completes credentialing and re credentialing applications, maintains inventory of contracts and terms, including rate grid with updated rates on all managed care contract agreements. Be able to interpret complex administrative and financial contract terms and communicate effectively regarding these with internal constituents and managed care payers. Stay updated on all pertinent payer billing and reimbursement changes and communicate information to necessary individuals.

Requirements

• Bachelor’s degree in Business, Accounting, Finance or Healthcare Management.
• At least 3-5 years of health care contract management experience required.
• Excellent understanding of payer contract language and reimbursement terms.
• Experience with CPT, ICD-9, and modifiers is essential.
• Basic knowledge of hospital Medicare and Medicaid fee schedules and reimbursement mechanisms.
• Experience with and knowledge of hospital third party billing requirements, claim payment methodologies, claim system requirements, procedures and controls.
• Good understanding of third-party contract language and reimbursement terms.
• Proficient in Excel, Word and Power Point.
• Proven excellence with oral and written communications.
• Strong attention to detail and possess a high analytical ability.
• Skilled in contract management software and/or adequate technical ability to learn this type of system.

Responsibilities

• overall management of payer contracts
• negotiation and review of payer contracts through data extraction and development of complex reimbursement modeling
• interfacing with outside vendors and consultants as needed
• identifies and assists with revenue cycle reimbursement issues
• identifies trends in payer payment practices and communicates with stakeholders
• completes credentialing and re credentialing applications
• maintains inventory of contracts and terms, including rate grid with updated rates on all managed care contract agreements
• interpret complex administrative and financial contract terms and communicate effectively regarding these with internal constituents and managed care payers
• stay updated on all pertinent payer billing and reimbursement changes and communicate information to necessary individuals

Benefits

• 403(b) Matching (Retirement)
• Dental insurance
• Employee assistance program (EAP)
• Employee wellness program
• Employer paid Life and AD&D insurance
• Employer paid Short and Long-Term Disability
• Flexible Spending Accounts
• ICHRA for health insurance
• Paid Annual Leave (Time off)
• Vision insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level