Managed Care Contract Analyst, Independence Pointe, FT, Days

Prisma Health • Greenville, SC

3d • Onsite

About The Position

Inspire health. Serve with compassion. Be the difference.

Job Summary
Coordinates system-wide hospital and physician services contracting initiatives and contract management, including but not limited to, strategy formulation, contract terms, and contract performance. Coordinates the implementation and servicing of all contracts for the entire system. Assists with system wide managed care education and communication.

Essential Functions
All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference
Perform contract language review, negotiate and recommend language and reimbursement changes/terms/provisions with payors in accordance with Prisma Health best practices independently as well as in collaboration with Manager, Managed Care Contracting, Financial Project Analysts and Director of Payor Contracting.
Coordinate and assists in managing the processing of all payer contracts and amendments within specified time frames or deadlines in collaboration with internal departments with minimal supervision. Manages and processes payer contracts and amendments including language and reimbursement review. Implements contracts and amendments with team members and internal departments. Tracks and monitors in database, contracts, amendments and renewals.
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.
Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers in collaboration with financial analysts.
Develops and maintain contracting decision making and tracking tools.
Participate and collaborate on special projects as assigned by Director or Vice President of Contracting.
Performs other duties as assigned.

Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.

Requirements

• Bachelor's degree in Business or a related field.
• Three (3) years of managed-care experience.
• Experience in a contracting or provider relations role preferred.
• Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques
• Knowledge of office equipment (fax/copier)
• Proficient computer skills (word processing, spreadsheets, database)
• Mathematical skills

Nice To Haves

• Experience in a contracting or provider relations role preferred.

Responsibilities

• Perform contract language review, negotiate and recommend language and reimbursement changes/terms/provisions with payors in accordance with Prisma Health best practices independently as well as in collaboration with Manager, Managed Care Contracting, Financial Project Analysts and Director of Payor Contracting.
• Coordinate and assists in managing the processing of all payer contracts and amendments within specified time frames or deadlines in collaboration with internal departments with minimal supervision. Manages and processes payer contracts and amendments including language and reimbursement review. Implements contracts and amendments with team members and internal departments. Tracks and monitors in database, contracts, amendments and renewals.
• 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.
• Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers in collaboration with financial analysts.
• Develops and maintain contracting decision making and tracking tools.
• Participate and collaborate on special projects as assigned by Director or Vice President of Contracting.
• Performs other duties as assigned.

What This Job Offers

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