Terms & Conditions Analyst - Remote

Tenet Healthcare Corporation

12d • $23 - $34 • Remote

About The Position

The Contracts Analyst is responsible for healthcare insurance reimbursement analysis; validating pre-load and post-load of contracts; applying independent judgment in the maintenance of the claims adjudication system; formulating and implementing system improvements, acting as a subject matter expert during contract negotiation processes, making recommendations to the Managed Care negotiators regarding terms of the contract; and collaborating with key stakeholders for the resolution of related issues. The Contracts Analyst responsibilities ultimately affect the business operations to a substantial degree.

Requirements

• This position requires knowledge of and the ability to perform all functions of the Contract Analyst.
• Advanced understanding of hospital billing form requirements (UB-04)
• Advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology
• Advanced Microsoft Office (Word, Excel)
• Advanced managed care/government contract interpretation skills
• Strong analytical abilities
• Minimum 1 year contract interpretation experience required
• Must be able to implement a systematic, self motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans
• Must be able to work in sitting position, use computer and answer telephone
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
• Ability to lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision.

Nice To Haves

• Advanced knowledge of query writing applications a plus
• Bachelor or Associate Degree preferred
• 3-5 years of relevant hospital business office experience preferred
• Ability to travel

Responsibilities

• Analyzes the Contract Terms and Conditions in a timely manner and makes recommendations for new contract loads, formulates, and implements amendments and changes, and rollover contracts as part of the client audit, deviating from established procedures as necessary.
• Regularly exercises discretion in analyzing and identifying issues associated with reprice impact reports after communication log issue have been corrected and re-priced. Formulates and implements solutions to identified issues and is empowered to make exceptions when required to move issues to resolution.
• Independently audits and verifies post-contract changes.
• Collaborates with Client Managed Care and Med Assets Account Rep to ensure contract profiles are pricing accurately, per contract language.
• Reviews internal requests for assistance and executes work list/queries for newly opened communication logs. Documents affected accounts as required.
• Identifies alternative opportunities in contract interpretation and revenue routing through the analysis of issues and, acting as a subject matter expert, provides alternative recommendations to management and staff. Activation of plan ID’s in mainframe system and MedAssets complying with NIC standards. Request approvals from Managed Care for NCCI edits if stated in contract and forward to the appropriate parties for loading.
• Communicates with appropriate leadership to ensure discrepancies are resolved prior to close of month end.
• Other duties as assigned

Benefits

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees