Provider Contract Analyst (Remote)

Highmark Health; Home (PA); Remote; USD 50,000 - 92,000; Full time

Job summary

A healthcare organization is seeking a Contract Manager to oversee contract management, including negotiations and financial reimbursement. The role requires strong analytical skills, with a preferred Bachelor's degree in finance or a related field. Candidates should have excellent communication and negotiation abilities, and the position is based in Pennsylvania with a salary ranging from $50,200 to $91,200.

Qualifications

• Associates Degree required; Bachelor's preferred in relevant disciplines.
• Experience preferred with 5+ years in Healthcare administration or finance.

Responsibilities

• Manage contracts including negotiations and financial reimbursement.
• Monitor compliance with contractual terms and report on key responsibilities.
• Act as intermediary for organization and outside entities.

Skills

Working knowledge of third party payment concepts

Experience with Microsoft Word and Excel

Medical terminology and coding

Strong organizational and analytical skills

Superior communication and negotiation skills

Education

Bachelor's Degree in Business, Finance, or related field

Job description

Overview

JOB SUMMARY: This job manages contracts including negotiations, contract development, contract renewal, and financial reimbursement. Acts as the intermediary between the organization and outside entity. Responds to contractual and payment issues both internally and externally. Ensures compliance with contractual terms.

Responsibilities

• Monitor activities by tracking the specific terms of each contract and maintaining a mechanism for monitoring and documenting compliance with those terms. Perform special studies/audits, coordinating office site visits and medical records reviews, ensuring resolution of member/provider complaints in timely manner.
• Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences. Conduct, collect and analyze data from claim and/or medical record reviews to continually improve the care and service to members and coordinate with the financial recovery areas to retract erroneous or inappropriate payments.
• Manage contracts including negotiations, contract development, contract renewal, and financial reimbursement.
• Act as the intermediary between the organization and outside entity to ensure all responsibilities as outlined in the contract are fulfilled. Serve as an advocate for managing expectations to achieve positive outcomes. Participate in educational and training sessions for provider billing staff to ensure understanding of and compliance with proper guidelines.
• Provide control and processing support for final provider settlements and initiating, documenting, processing, and establishing collection protocols for provider settlements.
• Work with sales and customer service to respond to questions/inquiries from customers/members related to appropriateness of services billed by providers. Consult with Medical Director on questions/issues related to medical necessity and appropriateness of services.
• Other duties as assigned or requested.

Education

Required

• Associates Degree in Business, Finance, Information Management, Healthcare Administration or Health related discipline

Substitutions

• None

Preferred

• Bachelor's Degree in Business, Finance, Information Management, Healthcare Administration or Health related discipline

Experience

Required

• None

Preferred

• 5 years in Healthcare administration/delivery/finance or a related field

Licenses or Certifications

Required

• None

Preferred

• Certified Public Accountant (CPA)

Skills

• Preferred working knowledge of third party payment concepts, and a solid understanding of health care finance and regional market environment
• Extensive experience with commonly used computer business applications to include but not limited to: Microsoft Word, Excel and PowerPoint
• Experience with medical terminology and coding
• Strong interpersonal organizational and analytical skills and the ability to perform under pressure within rigid time constraints, without the loss of efficiency, quality and professionalism as demonstrated by previous positions held
• Willingness and agreement to continue educational course work in direct relation to the position and travel for additional training or business purposes as necessary
• Demonstrated ability to analyze situations and data to identify issues, determine points of relevance and proper course of actions
• Superior communication (written and oral), negotiations, teamwork, and organizational skills as demonstrated through previous performance, testing and/or academic background
• Ability to identify, establish and meet goals and objectives

Language

None

Travel Requirement

0% - 25%

Physical, Mental Demands and Working Conditions

Position Type: Office-based

Teaches / trains others regularly: Occasionally

Travel regularly from the office to various work sites or from site-to-site

Works primarily out-of-the office selling products/services (sales employees): Rarely

Physical work site required: Yes

Lifting: up to 10 pounds: Constantly

Lifting: 10 to 25 pounds: Occasionally

Lifting: 25 to 50 pounds: Rarely

Compliance and Notices

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. All employees must comply with HIPAA and the company privacy policies and information security guidelines.

It is every employee’s responsibility to comply with the company’s Code of Business Conduct and applicable laws, rules, and regulations as well as company policies and training requirements.

Pay

Pay Range Minimum: $50,200.00

Pay Range Maximum: $91,200.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on protected veteran status or disabilities and prohibit discrimination based on any category protected by applicable law.

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