Senior Pricing Contract Analyst - Provider Contract Management

Health Care Service Corporation • Richardson, TX

275d • $60,300 - $133,400 • Onsite

About The Position

This position is responsible for system pricing development, supporting functions needed for contract financial analysis and performance. The individual in this role manages the coordination of internal/external audit requests, performs routine and ad hoc reporting, and maintains an understanding of provider contracts.

Requirements

• Bachelor Degree in Finance, Accounting or Math with 6 years experience in the Health Care Industry OR 8 years experience.
• 6 years experience in interpreting provider contracts and system requirements.
• 6 years experience in a managed care healthcare environment.
• 5 years experience in one or more of the following or similar claims adjudication and pricing systems: Blue Chip, MHS or HMO systems.
• Knowledge of CPT, HCPCS, ICD10, Revenue code and/or DRG coding practices, Relative Value Unit, Anesthesia, Durable Medical, and other methodology in support of current and future pricing scenarios.
• Flexibility to meet deadlines in an environment of constantly changing priorities and workloads.
• Leadership, analytical, problem-solving, organizational and communication skills.
• PC proficiency to include all Microsoft products.

Nice To Haves

• FACETS Claims Application experience is strongly preferred.
• Teradata/SQL queries.
• AGILE method of IT project development along with Optimized Waterfall.

Responsibilities

• Summarizing monthly HMO cap results by Provider Organization and researching extreme membership fluctuations.
• Maintaining HMO Risk tables.
• Reviewing non-standard contracts for system capability.
• Representing Provider Contract Management in internal/external audits, including Model Audit Rule (MAR) and SOC-1 audits.
• Providing documentation for audits as requested.
• Serving as technical expert on assigned subject areas.

Benefits

• Health and wellness benefits
• 401(k) savings plan
• Pension plan
• Paid time off
• Paid parental leave
• Disability insurance
• Supplemental life insurance
• Employee assistance program
• Paid holidays
• Tuition reimbursement
• Annual incentive bonus plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree