Maintains contract files and summaries to ensure the most current information is available.
ESSENTIAL FUNCTIONS include the following:
Researches, analyzes and reviews payor contracts.
Audits contracts to ensure implementation is in accordance with the agreement.
Performs review of contracts to ensure appropriateness of payments.
Evaluates contracts and makes recommendations as necessary.
Reviews and audits fee schedules within the Company’s billing system. Coordinates updates as needed.
Maintains records and prepares reports.
Identifies potential exposures to the company and facilitates resolution.
Corresponds and communicates with payors regarding discrepancies. Investigates and resolves queries as necessary.
Creates and maintains files.
Prepares managed care and/or other contract reports, as required.
Responds to billing staff inquiries and troubleshoots, as necessary.
Performs other duties as assigned.
Bachelor’s degree (B.A. or B.S.) from a four-year college or university or equivalent combination of education and experience.
Minimum two (2) years contract analyst related experience.
Comprehensive understanding of insurance contract processes and implementation.
Demonstrated commitment to exceptional professionalism, confidentiality and service to customers.
Effective communication skills for accurate, concise, and organized verbal and written communication.
Good interpersonal skills and ability to build professional relationships.
Ability to work effectively as a team member.
Effective organizational, time management and planning skills.
Knowledge of Windows based office technologies (i.e. Word, Excel, etc.).
Demonstrated claims management experience and ability to handle multiple priorities simultaneously.
Knowledge of data analysis methods.