Contract Compliance Analyst III

Thornton Tomasetti; United States; Remote; USD 61,000 - 123,000; Full time

Job summary

Abbott is seeking a Contract Compliance Analyst III to facilitate contract implementation and revenue pull-through activities, ensuring payer reimbursement and compliant billing across internal and external partners. The role emphasizes collaboration with Field Managed Care, finance, and legal teams to optimize revenue recovery.

Remote position with Wisconsin residency required; requires 3+ years in billing/reimbursement, plus Excel and Epic experience.

Qualifications

• 3+ years of experience in billing/reimbursement, coverage, claims, and appeals.
• Understanding of public and private Managed Care payers and reimbursement processes.
• Familiarity with contract basics, product coverage, and pull-through rationale.
• Proficiency with Excel and Epic or similar database systems.

Responsibilities

• Develop communication for contracts, amendments, and notifications for internal Revenue Cycle Team customers and collaborate with field management in payer negotiations.
• Support development and maintenance of contract databases and contract management systems with credentialing and legal teams.
• Collaborate with finance/analytics to analyze negative revenue pull-through and address payer-specific issues.
• Assist in executing pull-through plans to meet revenue recovery goals.
• Identify revenue opportunities and leverage CMS for non-contracted Managed Medicare/non-payments.

Skills

Billing/reimbursement

Managed care payer knowledge

Pull-through rationale

Tools

Excel

Epic

Job description

JOB DESCRIPTION:

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries.

The Contract Compliance Analyst III will facilitate contract implementation and revenue pull-through activities, both proactive and reactive, with internal and external parties. This position will ensure the public and private payer reimbursement. The role is also fundamental in reviewing that billing and payment processes are efficient, timely, and in compliance with corporate goals, contracts and/or regulations. This position will facilitate and manage contract implementation for operations and partner with Managed Care to develop and maintain agreements that provide medical providers and patients with access to our assays while aligning with Exact Sciences goals and objectives.

Location:

This is a remote position; candidates must reside in the state of Wisconsin.

ESSENTIAL DUTIES:

• Develop communication for contracts, amendments, and notifications for the internal Revenue Cycle Team (RCT) customers and collaborate with the Field Managed Care team in negotiations with payers for operational optimization.


• Play a role in the development and maintenance of a contract database and contract management system, working with the credentialing and legal teams.


• Collaborate with finance and analytics to identify, analyze, and determine next steps to address negative revenue pull-through scenarios specific to payers and across payer segments; including Medicare Advantage, Blues, Medicaid, etc.


• Collaborate with RCT Managers and specialists to develop and leverage relationships with billing operations staff and payers when resolving claim adjudication issues, both contractual and non-contractual.


• Support execution of pull-through plans to meet quarterly/annual revenue recovery goals.


• Identify broad revenue opportunities that span a particular customer segment; including utilizing Content Management Systems (CMS) for noncontracted Managed Medicare non-payments and the Employer Coalition initiative.


• Consistently identify opportunities to recover revenue.


• Collaborate with the Managed Care team to identify and prioritize plan(s) utilizing key payers for targeted efforts to impact coverage policy decisions.


• Facilitate conversations with appropriate Exact personnel early in the contracting process to provide an overview of the account to avoid delay in implementation down the road.


• Strong attention to detail and organizational skills.


• Strong analytical skills.


• Ability to drive to results with a high emphasis on quality.


• Ability to present recommendations supported by analytical evaluations.


• Strong ability to prioritize and multi-task.


• Ability to integrate and apply feedback in a professional manner.


• Excellent communication, both written and verbal, across internal and external personnel.


• Ability to collaborate and work effectively as a team member.


• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.


• Support and comply with the Quality Management System team’s policies and procedures.


• Maintain regular and reliable attendance.


• Ability to act with an inclusion mindset and model these behaviors for the organization.


• Ability to work designated schedule.


• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.


• Ability to work on a computer and phone simultaneously.


• Ability to use a telephone through a headset.

MINIMUM QUALIFICATIONS:

• 3+ years of experience in billing/reimbursement, coverage, claims, and appeals.


• Demonstrated understanding of public and private Managed Care payers and reimbursement process.


• Demonstrated understanding of market-related issues, contract basics, product coverage, and pull through rationale.


• Proficient with Excel and Epic or similar database; demonstrated ability to maintain competency levels.


• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.

PREFERRED QUALIFICATIONS:

• Knowledge of and/or experience with government Managed Care payers.


• Knowledge of billing and coding.

Applicants must be currently authorized to work in country where work will be performed on a full or part-time basis. We are unable to sponsor or take over sponsorship of employment visas at this time.

The base pay for this position is $61,300.00 – $122,700.00 In specific locations, the pay range may vary from the range posted.

JOB FAMILY:

Sales Support & Administration

DIVISION:

ONCO Cancer Diagnostics

LOCATION:

United States of America : Remote

ADDITIONAL LOCATIONS:

Not specified

WORK SHIFT:

Standard

TRAVEL:

Not specified

MEDICAL SURVEILLANCE:

Not Applicable

SIGNIFICANT WORK ACTIVITIES:

Not Applicable

Abbott is an Equal Opportunity Employer of Minorities/Women/Individuals with Disabilities/Protected Veterans. EEO is the Law link - English: http://webstorage.abbott.com/common/External/EEO_English.pdf EEO is the Law link - Espanol: http://webstorage.abbott.com/common/External/EEO_Spanish.pdf

Abbott is about the power of health. For more than 135 years, Abbott has been helping people reach their potential - because better health allows people and communities to achieve more. With a diverse, global network serving customers in more than 160 countries, we create new solutions - across the spectrum of health, around the world, for all stages of life. Whether it's next-generation diagnostics, life-changing devices, science-based nutrition, or novel reformulations, we are advancing some of the most innovative and revolutionary technologies in healthcare, helping people live their best lives through better health.

The people of Abbott come to work each day with relentless energy, enthusiasm and a promise to enhance the health and well-being of millions of people. They push the boundaries to help manage and treat some of life's greatest health challenges.

We invite you to explore opportunities at Abbott, to see if your talents and career aspirations may fit with our openings. An equal opportunity employer, Abbott welcomes and encourages diversity in our workforce.

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