Perform day-to-day duties and testing of contract implementation, including UAT and assuring that systems accurately reflect a contract’s negotiated terms.
Bachelor’s degree in business, finance, related field, or equivalent experience. 0-2 years of provider contract implementation or contract analysis experience in managed care, health care or TPA setting. Government programs and Amisys experience preferred.
Bachelor’s degree in business, finance, related field, or equivalent experience. 2-4 years of provider contract implementation or contract analysis experience in managed care, health care or TPA setting. Familiarity with rate methodology and contract language. Strong problem solving and analytical skills. Government programs and Amisys experience preferred.
• Perform audits of provider setup within the provider information system (AMISYS) to ensure accurate contract implementation and subsequent claims processing
• Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc.
• Assist with the health plan’s workflow to assure timely, accurate submission and implementation of contracts
• Conduct internal audits of contracts and related files to ensure compliance with corporate standards related to contracts and their implementation
• Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments
• Troubleshoot and problem solve contract implementation issues
• Review new and current provider contracts and established state guidelines
• Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plan, claims and corporate management and information systems staff
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...