• Provider Network Contract Analyst

    Job Locations US
    ID
    2019-16907
    Category
    Akeso
    Facility
    Akeso Talent Engagement
    Type
    Perm Placement
  • Overview

    Akeso Talent is looking to add a Network Contract Analyst to our team which will be responsible for completing contract administration duties to ensure that claims are paid in accordance with contract provisions and that plan payment levels are reasonable and accurate based on the scope of services rendered. 

    Responsibilities

    • Developing anticipated settlements to providers when systematic payments don't adequately address all reimbursement provisions of provider contracts to ensure that adequate reserve requirements are provided for by the plan
    • Responding to provider inquiries related to contracts/payments
    • Resolving, documenting, and communicating conclusions related to reimbursement issues or problems 
    • Participating in the drafting or amending of provider contracts
    • Completing data analysis to assist with provider contract negotiations
    • Researching, analyzing, and evaluating provider payment modifications at the State and Federal level
    • Performing studies to monitor and assess changes in provider billing patterns, charge description masters and other variable reimbursement provisions
    • Providing documentation for claim payment audits and surveys (BCBSA, FEP, Medicare, Model Audit Rule, etc.)

    Qualifications

    This position requires at least 2-3 years of experience in a health care environment, including proven analytical expertise. A Bachelor's Degree in a related field OR an Associate's Degree AND sufficient work experience in health care/insurance pertaining to reimbursement or finance is required.

     

    Experience with Microsoft Office Suite products including proficiency with Excel utilizing formulas, pivot tables, and other advanced functions is required, as well as a familiarity with plan operations, provider contract provisions, provider and facility types, claim submission requirements, and commercial/Medicare reimbursement methodologies.

     

    This position also requires the ability to perform in a team environment, as well as proven ability to work independently with minimal supervision. Additionally, the ability to analyze provider reimbursement data and prepare detailed, organized reports and studies is essential, as well as the ability to communicate results professionally and develop effective working relationships with provider financial personnel.  

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