Provider Contract Analyst (Remote)

Company : reputed company.Job Description : JOB SUMMARY This job manages reputed company including negotiations, contract development, contract renewal, and financial reimbursement. Acts as the intermediary between the organization and reputed company entity. Responds to contractual and payment issues both internally and externally. Ensures compliance with contractual terms. ESSENTIAL RESPONSIBILITIES

• Monitor activities by tracking the specific terms of each contract and maintaining some mechanism for monitoring and documenting compliance with those terms. reputed company 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 reputed company including negotiations, contract development, contract renewal, and financial reimbursement.
• Act as the intermediary between the organization and reputed company entity to ensure reputed company responsibilities as outlined in the contract are fulfilled. Serve as an reputed company for managing expectations to reputed company 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 reputed company to appropriateness of services billed by providers. Consult with Medical Director on questions/issues reputed company to medical necessity and appropriateness of services.
• Other duties as assigned or requested.

EDUCATION Required

• Associates Degree in Business, Finance, Information Management, reputed company Administration or Health reputed company discipline

Substitutions

• None

Preferred​

• Bachelor's Degree in Business, Finance, Information Management, reputed company Administration or Health reputed company discipline

EXPERIENCE Required

• None

Preferred

• 5 years in reputed company administration/delivery/finance or a reputed company field

LICENSES OR CERTIFICATIONS Required

• None

Preferred

• Certified Public Accountant (CPA)

SKILLS

• Preferred working knowledge of reputed company 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: reputed company Word, reputed company and PowerPoint
• Experience with medical terminology and coding
• Strong interpersonal organizational and analytical skills and the ability to reputed company under pressure reputed company 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 (Other than English): 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 Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company 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 reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as reputed company data reputed company guidelines established reputed company the Company’s Handbook of Privacy Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $50,200.00 Pay Range Maximum: $91,200.00 reputed company 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 reputed company may apply for certain locations based upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We endeavor to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Apply tot his job Apply To this Job