Managed Care Contract Specialist - FT - Day - Managed Care Pennington NJ

Capital Health (US)•Hopewell, NJ

2d•Onsite

About The Position

Under the direction of the VP of Payer Relations, this position is responsible for reviewing all managed care contracts and their yearly updates. The specialist works with departmental leadership to ensure all contracted rates are loaded in a timely manner. This role involves the maintenance and monitoring of contracts by running ad-hoc reports to ensure compliance and accuracy of pricing according to various contracts. The specialist also collaborates with the Management team in the Revenue Cycle department to verify all pricing discrepancies.

Requirements

High School degree or equivalent.
Five years' experience in hospital-based billing.
Proficient knowledge of healthcare billing.
Outstanding organization skills.
Excellent verbal and written communication skills.
Proficient in Microsoft Office.
Ability to quickly learn the billing system to become proficient.
Ability to manage multiple tasks simultaneously and ability to change priorities when necessary to meet deadlines.
Demonstrates good judgment as well as attention to detail.

Nice To Haves

Bachelor’s degree preferred.
ICD-10 knowledge preferred.

Responsibilities

Facilitates and coordinates process standardization with vendor to promote accurate contractual allowances in the contract management tool.
Reviews claim calculations in contract management tool, identifies discrepancies between the tool and contractual terms and works with the vendor or the payer to resolve discrepancies.
Performs root cause analysis behind payment calculation variances and identifies improvement opportunities for contract management software vendor as appropriate.
Provides ongoing evaluation and assessment of payer contracts, correlation tables, fee schedules, etc. through claims data to ensure the contract management tool remains current and accurate.
Coordinates with management and other revenue cycle leaders on contract valuation issues resulting in payment discrepancies.
Assures payment discrepancies are quantified timely and accurately.
Partners with Hospital and Professional Billing Department to engage with different payers in providing feedback regarding trends and issues.
Assures compliance of payers with regulatory guidelines and contract provisions.
When discrepancies are found, identifies if it's due to the contract load or due to the payer. When due to the contract load, it goes back to the vendor to have any incorrect loads updated. When due to payer issues, adds all issues to the Payer spreadsheet and works with our Payer Representative to resolve and completed in conjunction with revenue cycle management team.
Obtains a thorough understanding of payer reimbursement practices and procedures.
Contributes to topics included on payer agendas and spreadsheets to support Billing and Contract Management leadership in efficient communication for consistent resolution of payer contracting issues.
Remains current with changes in payer medical policies that impacts claim pricing methodologies and adjusts contract management software and/or communicates impact to management.
Performs other duties as assigned.