Managed Care Contract Analyst, Independence Pointe, FT, Days

Prisma Health; South Carolina; On-site; USD 70,000 - 100,000; Full time

Job summary

Prisma Health seeks a Contracts Specialist to coordinate system-wide hospital and physician services contracting, strategy, and performance management. The role supports system-wide contract servicing and payer communications.

The position emphasizes timely processing of payer contracts, analytical assessments of financial impact, and collaboration with the Managed Care Contracting team to ensure best-practice terms and effective provider relations.

Qualifications

• Education: Bachelor’s degree in Business or related field.
• Experience: Three years of managed-care experience; contracting or provider relations preferred.
• In lieu: High school diploma with five years managed care experience acceptable.

Responsibilities

• Review, negotiate, and recommend contract language and reimbursement terms with payors.
• Coordinate processing of payer contracts and amendments within deadlines.
• Track contracts, amendments and renewals in the database.
• Provide problem-solving support and proactive payer communications.
• Develop contracting decision tools and participate in special projects.
• Analyze financial and operational impact of payer changes.
• Maintain relationships with payers and internal customers.

Skills

Health-insurance knowledge

Proficient computing

Mathematical skills

Office equipment

Education

Bachelor's degree in Business or related field

Tools

Microsoft Word

Excel

Database software

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Coordinates system-wide hospital and physician services contracting initiatives and contract management, including but not limited to, strategy formulation, contract terms, and contract performance. Coordinates the implementation and servicing of all contracts for the entire system. Assists with system wide managed care education and communication.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference
• Perform contract language review, negotiate and recommend language and reimbursement changes/terms/provisions with payors in accordance with Prisma Health best practices independently as well as in collaboration with Manager, Managed Care Contracting, Financial Project Analysts and Director of Payor Contracting.
• Coordinate and assists in managing the processing of all payer contracts and amendments within specified time frames or deadlines in collaboration with internal departments with minimal supervision. Manages and processes payer contracts and amendments including language and reimbursement review. Implements contracts and amendments with team members and internal departments. Tracks and monitors in database, contracts, amendments and renewals.
• Provide problem solving support to Prisma Health affiliates and departments. Work closely with payers to ensure that Prisma Health receives all provider manual changes, provider bulletins, benefit plan changes and other payer documents. This position distributes this information throughout Prisma Health in a timely fashion. Conduct pro-active communication, contract compliance, and educational sessions. Develop and maintain effective relationships with payers and internal customers.
• Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers in collaboration with financial analysts.
• Develops and maintain contracting decision making and tracking tools.
• Participate and collaborate on special projects as assigned by Director or Vice President of Contracting.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - Bachelor's degree in Business or a related field.
• Experience - Three (3) years of managed-care experience. Experience in a contracting or provider relations role preferred.

In Lieu Of

• In Lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: high school diploma and five (5) years of managed care experience in healthcare administration, health insurance, provider contracting, or a related field.

Required Certifications, Registrations, Licenses

• N/A

Knowledge, Skills and Abilities

• Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques
• Knowledge of office equipment (fax/copier)
• Proficient computer skills (word processing, spreadsheets, database)
• Mathematical skills

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

Corporate

Department

Managed Care Contracting

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.