Senior Provider Contracting Analyst

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

20h•Onsite

About The Position

This position works within the Provider Contracting department and provides analytical and other support for provider contracting, contract administration, and departmental initiatives and projects. The incumbent supports the data and analytical needs of those leading provider negotiations. They monitor and facilitate the contract loading and ongoing contract administration in Highmark systems. This role interfaces directly with other departments (Reimbursement, etc.) on the ongoing departmental needs to support contracting and administration activities.

Requirements

5 years in the Health Insurance Industry
Analytical and Logical Reasoning/Thinking
Contracts Administration
Problem-Solving
Customer Service
Requirements Gathering
Reporting
Data Gathering and Analysis

Nice To Haves

Bachelor's Degree in Business, Finance, Information Management, Healthcare Administration or Health Related discipline

Responsibilities

Monitor activities by tracking the specific terms of each contract and maintaining a mechanism for monitoring and documenting compliance with those terms and perform special studies/audits for all contracts.
Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences.
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.
Support provider contracting activities 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.
Provide 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.
Other duties as assigned.