Provider Contract Analyst

Highmark Health • PA, Working at Home - Pennsylvania, PA

2d • $68,400 - $105,900 • Remote

About The Position

This role is responsible for managing all aspects of post-acute care contracting, with a specific focus on home health, hospice, and skilled nursing facilities. The Provider Contract Analyst will be involved in the entire contract lifecycle, including negotiations, development, and ownership changes ensuring favorable financial reimbursement and compliance with all contractual terms. This position acts as a critical intermediary between the organization and external entities, proactively addressing contractual and payment issues both internally and externally. The analyst will be heavily involved in provider-facing activities such as assisting with the Helion Provider Help Desk to answer questions related to Utilization Management and claims processing, collaborating with the development team to draft agreements, and assisting with health plan contract negotiations. This is a remote based role however would prefer the candidate be in the Western, PA territory.

Requirements

• Associates degree in Business, Finance, Information Management, Healthcare Administration or Health Related Discipline
• 5 years experience in health care administration/delivery/finance or a related field

Nice To Haves

• Bachelor's degree in business, finance, information management, healthcare administration or health related discipline
• MBA
• CPA
• working knowledge of third party payment concepts, and a solid understanding of health care finance and regional market environment
• Extensive experience with commonly used computer business applications to include but not limited to: Microsoft Word, Excel and PowerPoint
• Experience with medical terminology and coding
• Strong interpersonal organizational and analytical skills and the ability to perform under pressure within rigid time constraints, without the loss of efficiency, quality and professionalism as demonstrated by previous positions held
• Willingness and agreement to continue educational course work in direct relation to the position and travel for additional training or business purposes as necessary
• Demonstrated ability to analyze situations and data to identify issues, determine points of relevance and proper course of actions
• Superior communication (written and oral), negotiations, teamwork, and organizational skills as demonstrated through previous performance, testing and/or academic background
• Ability to identify, establish and meet goals and objectives

Responsibilities

• Monitor activities by tracking the specific terms of each contract and maintaining some mechanism for monitoring and documenting compliance with those terms.
• Perform special studies/audits, coordinating office site visits and medical records reviews, ensuring resolution of member/provider complaints in timely manner.
• Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences.
• Conduct, collect and analyze data from claim and/or medical record reviews to continually improve the care and service to members and coordinate with the financial recovery areas to retract erroneous or inappropriate payments.
• Manage contracts including negotiations, contract development, contract renewal, and financial reimbursement.
• Act as the intermediary between the organization and outside entity to ensure all responsibilities as outlined in the contract are fulfilled.
• Serve as an advocate for managing expectations to achieve positive outcomes.
• Participate in educational and training sessions for provider billing staff to ensure understanding of and compliance with proper guidelines.
• Provides control and processing support for final provider settlements and initiating, documenting, processing, and establishing collection protocols for provider settlements.
• Work with sales and customer service to respond to questions/inquiries from customers/members related to appropriateness of services billed by providers.
• Consults with Medical Director on questions/issues related to medical necessity and appropriateness of services.
• Other duties as assigned or requested.

Benefits

• Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree