Contract System Management Analyst - Remote

Option Care; Lincoln (NE); Remote; USD 46,000 - 77,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

PTO

Job summary

Option Care Health, Inc. is seeking a Contract Management Specialist to prepare third party payer contracts for loading into the CPR Plus system and pharmacy operations platform.

You will interpret billing rules, pricing terms, and contract language to support accurate billing and revenue cycle success. You will maintain payer records, update pricing and codes, collaborate with Contracting, Pricing, Revenue Cycle Management, and IT, and provide advanced reports.

Qualifications

• Bachelor’s degree or HS diploma with 5+ years in Revenue Cycle Management, Contract Management, or home infusion related roles.
• Strong analytical and problem-solving skills.
• Advanced Excel skills with VLOOKUP, basic formulas, and pivot tables.
• Experience with HCPCS coding and drug pricing sources (AWP, ASP, WAC).
• Intermediate MS PowerPoint and Word skills.

Responsibilities

• Create and maintain third party payer contract records and pricing terms.
• Update pricing, coding, and business rules as needed.
• Coordinate with Contracting and Revenue Cycle Management for on-site integrations.
• Provide detailed system reports related to payer pricing strategies.
• Assist training of Contract System Management Specialists.

Skills

Excel

Data analysis

Problem solving

Team collaboration

HCPCS coding

Education

Bachelor's degree

Tools

CPR Plus

Microsoft PowerPoint

Microsoft Word

Job description

Extraordinary Careers. Endless Possibilities. With the nation’s largest home infusion provider, there is no limit to the growth of your career. Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re‑imagining the infusion care experience for patients, customers and team members. Join a company that is taking action to develop an inclusive, respectful, engaging and rewarding culture for all team members. At Option Care Health your voice is heard, your work is valued, and you’re empowered to grow. Cultivating a team with a variety of talents, backgrounds and perspectives makes us stronger, innovative, and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare.

Job Description Summary:

Responsible for preparing third party payer agreements to load in the pharmacy management system for Option Care. Responsible for building the third party payer agreements in the pharmacy operations system (CPR Plus). Research, understand, and interpret the applicable billing rules, billing units, and terms and conditions of the agreement in order to drive success in billing and collecting on the services provided by Option Care. Supports the Managers and Directors within the Commercial Contracting group facilitating a cross functional and collaborative working relationship with Contracting, Pricing, Trade, and Revenue Cycle Management. Collaborate closely with the Contract Operations Department, as well as Revenue Cycle Management and the CMCs.

Job Responsibilities (listed in order of importance and/or time spent):

Create and build the record for third party payer contract agreements. This includes creating insurance plans, researching and inputting business rules, and loading the contract pricing terms for implementation Maintain assigned payer agreements. Update and execute any changes to pricing, coding, or business rules. Responsible for working with the Contracting and Revenue Cycle Management on site integration to insure proper insurance plans are accounted for, and assigned to the correct location Identify contracts that are not generating revenue to see if there is an opportunity to purge records and reduce insurance plan selection errors Audit third party agreement pricing tables to ensure accuracy to improve Revenue Cycle Management success Collaborate with Pricing team when trends are identified to insure proper insurance plan was utilized so that we are maximizing profitability by reducing bad debt and other payer adjustments Collaborate with IT and Revenue Cycle Management on System Upgrades that could impact contract build, as well as make recommendations on system enhancement opportunities Collaborate with Revenue Cycle Management to insure proper insurance plans are set up, and able to be utilized by CMC Provide detailed advanced system reports for revenue cycle management and pricing teams as it relates to payer pricing strategies that are being input into the system Assist with training of Contract System Management Specialists

Supervisory Responsibilities:

Does this position have supervisory responsibilities? (i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.) No

Basic Education and/or Experience Requirements

Bachelor’s degree, or High School Diploma with at least 5 years of experience in Revenue Cycle Management, Contract Management, Home Infusion intake, or home infusion pharmacy technician.

Basic Qualifications

Ability to work in a deadline driven environment Strong analytical and problem solving skills Ability to function individually as well as in cross-functional teams. Ability to identify improvement and growth opportunities Advanced level skill in Microsoft Excel with an ability to do VLOOKUP up, basic formulas, and pivot table work. Experience with analyzing and reporting data ability to identify issues, model trends, or exceptions to drive improvement of results and find solutions Experience with HCPCS coding, and Drug Pricing Sources (AWP, ASP, WAC) Intermediate level skill in Microsoft PowerPoint and Microsoft Word

Travel Requirements

Willing to travel up to 10% of the time for business purposes (within state and out of state)

Preferred Qualifications & Interests (PQIs)

CPR Plus experience Contract Management experience Experience with Medicare, Medicaid, PBM, and other third party payer payment guidelines

Salary

Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data.

Pay Range

Pay Range is $46,069.64-$76,767.74

Benefits

• Medical, Dental, & Vision Insurance
• Paid Time off
• Bonding Time Off
• 401K Retirement Savings Plan with Company Match
• HSA Company Match
• Flexible Spending Accounts
• Tuition Reimbursement
• myFlexPay
• Family Support
• Mental Health Services
• Company Paid Life Insurance
• Award/Recognition Programs

Equal Employment Opportunity

Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.

For over 40 years, Option Care Health has provided adult and pediatric patients with an alternative to hospital infusion therapy. With more than 2,900 clinical experts, Option Care Health is able to provide high-quality infusion services for nearly all patients with acute and chronic conditions across the United States, resulting in high quality outcomes at a significantly reduced cost. Option Care Health has more than 70 infusion pharmacies and 100 alternate treatment sites. We are guided by our purpose to provide extraordinary care that changes lives through a comprehensive approach to care along every step of the infusion therapy process including: intake coordination, insurance authorization, resources for financial assistance, education and customized treatments.