Contract Integrity Specialist

2 days ago

Murray, United States Intermountain Healthcare Full time
Job Description:
The Contract Integrity Specialist for SelectHealth are responsible for reviewing contracts and auditing systems to ensure accurate contract, Medicare, Medicaid and fee schedule setup, and to identify risks and opportunities associated with current processes. This role works independently on assignments as well as collaborating with a team and generally performs moderately complex to complex assignments.

In collaboration with the Analysts and leadership, this position is responsible for ensuring compliance with internal policies and procedures, external regulations, and contracts related to payment integrity and monitoring, reviewing and interpreting Medicare and Medicaid policies, payment methodologies, and updates to ensure accurate system setup. Analyzes and interprets contracts and ensures accurate system configuration for out-of-network providers. Acquires and maintains an understanding of the technical and functional architecture of assigned systems and reviews and validates system configuration of all provider types and vendor pricing and editing against contracts and Medicare and Medicaid pricing methodologies. Works to identify issues with configuration, contracts, and vendor pricing, and identifies modifications needed to resolve.

Builds and maintains interdepartmental solid working relationships and uses business knowledge and effective communication skills to work with internal departments to resolve issues and ensure contractual and system accuracy. Queries and analyzes data related to the payment of contracts, fee schedules and Medicare and Medicaid regulations and methodologies. Conducts internal and external contract auditing, including but not limited to claims payment, provider incentive contracts and payments, contracting implementation, and updates and makes recommendations based on analyses. Maintains reporting to track items researched, and to measure performance of revenue and recovery programs related to contract compliance. Provides concise status updates in huddles and assists with projects at the direction of management. May train or mentor others on the subject matter, lead projects, or perform other tasks as assigned.

Minimum Qualifications

Demonstrated experience and expertise working with claims policies and procedures, payment methodologies, or health care contracting

Demonstrates analysis, critical thinking and problem-solving skills.

Demonstrated Intermediate proficiency with the Microsoft Office suite including Word and Excel

Demonstrated knowledge of health insurance professional, facility, ancillary (DME, Home Health) contracts, and integration into payment systems

Knowledge of state regulatory requirements, federal requirements, and insurance regulations.

Preferred Qualifications

Bachelor's Degree in business management or health-related field. Degree must be obtained through an accredited institution. Education is verified.

Three years of experience working with claims policies and procedures, payment methodologies, or health care contracting.

Ability to run basic queries and reports

Experience with Data mining, Actuarial, AI Development, Statistics/Mathematics, or Contract Configuration/Pricing.

Capable of building and maintaining interdepartmental solid working relationships.

Ability to establish and maintain rapport with co-workers, physicians, or other health care providers

Ability to perform job tasks independently with minimal supervision

Sound judgment, critical thinking, and decision-making skills

Excellent verbal, written, analytical, and public presentation skills

Physical Requirements:

Anticipated job posting close date:
09/15/2024

Location:
SelectHealth - Murray

Work City:
Murray

Work State:
Utah

Scheduled Weekly Hours:
40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$32.77 - $51.61

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers, and for our Colorado, Montana, and Kansas based caregivers; and our commitment to diversity, equity, and inclusion.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

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