Managed Care Contract Analyst, Corporate, FT, Day

Prisma Health • Greenville, SC

3d

About The Position

Inspire health. Serve with compassion. Be the difference. Job Summary Coordinate system-wide hospital and physician services contracting, including but not limited to, strategy formulation, contract terms and contract performance. Coordinate the implementation, presentation and servicing of all contracts for the entire system. Provides system wide managed care education and communication.

Requirements

• Bachelor's Degree.
• 5 years- Managed-care experience, preferably in a contracting or provider relations role.
• Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques- Required
• In lieu of manage care experience, fie years experience in healthcare administration, health insurance, or provider contracting.

Responsibilities

• Coordinate the processing of all payer contracts and amendments.
• Coordinate all the steps required in the development, review and processing of new contracts, contract renewals and contract amendments with payers.
• Coordinate all required steps for the execution of contracts and amendments and ensure completion or execution of finalized contracts and amendments within specified time frames or deadlines.
• Perform detailed review of the business terms in contracts and amendments received from payers, identify unacceptable terms and recommend revised terms that meet the needs of Prisma Health.
• Negotiate single case agreements when necessary.
• Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers.
• Develops and maintain contracting decision making and tracking tools.
• Develops model contracts or contract language for use in proposing contract or amendments to payers.
• Establish reporting techniques that will identify areas of concern and prepare recommendations to address any issues.
• Provide problem solving support to Prisma Health affiliates and departments.
• Work closely with payers to ensure that Prisma Health receives all provider manual changes, provider bulletins, benefit plan changes and other payer documents.
• This position distributes this information throughout Prisma Health in a timely fashion.
• Conduct pro-active communication, contract compliance, and educational sessions.
• Develop and maintain effective relationships with payers and internal customers

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees