Provider Contracts Analyst

Mortenson Dental•Louisville, KY

About The Position

The Provider Contracts Analyst will serve as the subject matter expert on insurance plans, analyzing and evaluating them to determine optimal design. This role involves assessing the impact of revenue optimization on the business and patients, and potentially communicating proactively with practices to assist with patient communication. Utilizing CIV data, the analyst will develop strategies to improve eligibility processes and identify carrier-related issues. A key responsibility includes performing in-depth analyses of practices that have not shown improvement in insurance estimates since onboarding with CIV. The analyst will also examine revenue cycle data to support leadership and practice billing teams in revenue management. This includes overseeing the acquisition, creation, distribution, and validation of fee schedules, as well as addressing practice inquiries regarding fee schedules and provider participation status to identify and resolve inaccuracies. The analyst will determine the scope of any inaccuracies and implement corrective changes. Furthermore, the role involves using plan and regional data to make recommendations on carrier participation, coordinating with practices, third-party vendors, and the RCM team, and supporting the credentialing team with provider applications. Various other duties may be requested by the supervisor.

Requirements

High school diploma or equivalent.
Associate Degree or Equivalent Experience.
3 - 5 years of experience working with insurance companies.
Extensive knowledge of different types of coverage and policies.
Analytical problem-solving skills.
Basic Excel Experience.

Nice To Haves

Bachelor's Degree or Equivalent experience.
Open Dental knowledge.
Dental insurance verification experience.
Experience working with large sets of data.
Advanced Excel.
Open Dental.

Responsibilities

Serve as the subject matter expert (SME) on insurance plans.
Analyze and evaluate insurance plans to determine optimal design.
Determine the impact of revenue optimization on the business and the patient.
Communicate with the practice proactively to assist with patient communication.
Using CIV data, develop ways to improve eligibility processes and to determine when we have carrier-related issues.
Perform deep dives into practices that have not improved on insurance estimates since onboarding with CIV.
Analyze revenue cycle data to assist leadership and practice billing teams in revenue management.
Oversee obtaining, creating, distributing, and validating the accuracy of fee schedules.
Review practice inquiries regarding fee schedules and provider participation status to determine the cause of inaccuracy.
Determine the scope of the inaccuracy (practice, region, company) and take appropriate steps to resolve the issue.
Implement necessary changes once an issue is resolved.
Use plan and regional data to make recommendations on carrier participation.
Coordinate with the practice, third-party vendors, and the RCM team.
Support the credentialing team with provider applications.
Perform various other duties as requested by the supervisor.