Implement all provider contracts, including any pertinent changes and modifications applicable to these contracts.
Bachelor’s degree in related area or equivalent experience. 6+ years of provider contract implementation, contract analysis, or claims payment system experience in managed care, health care, or TPA setting. Understanding of rate methodology and contract language. Strong problem solving and analytical skills. Government programs and Amisys experience preferred.
- Ensure accurate contract implementation and subsequent claims processing through activities like provider setup, UAT testing, etc.
- Perform random audits of provider setup within the provider information system (AMISYS) to ensure accurate contract implementation and subsequent claims processing
- Manage the health plan’s workflow to assure timely, accurate submission and implementation of contracts.
- Participate in provider contracting activities & interact directly with providers to improve communication and minimize contract implementation issues/errors.
- Develop, communicate, implement and maintain production and quality standards
- Act as health plan interface on software product upgrades/implementations which affect contract implementation.
- Assess state changes in reimbursement and/or benefits and request appropriate changes to configuration to correctly & timely implement these changes.
- Act as the health plan interface with Corporate Contracting and other business owners as applicable for all questions regarding implementation and claims accuracy issues.
- Document and report deviations as well as coordinate the business process of such deviations from contract standards ensuring that they have appropriate approval and can be effectively administered prior to execution.
- Conduct internal audits of contracts and related files to ensure compliance with corporate standards related to contracts and their implementation.
Centene Corporation - 2 years ago
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Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...