Manager of Contracts

6 days ago

Monmouth Beach, United States Equus Full time

**Company Description**
We help job seekers and career changers prepare for and advance in careers with a focus on sustainable, high-growth, high-demand industries. Our committed and well-trained workforce professionals deliver comprehensive workforce solutions at integrated career centers, sector-focused centers and community, and partner sites.
- Manages payor contracting admin duties including payor contracting cycle (new and amended)
- Rolls out new and amended payer contracts and/or payer policies to RCM and Operations and audits for compliance
- Manages payor notifications distribution, action items and proper storage
- Manages notifications from Amerita to payors such as address changes and location updates to contracts
- Oversees the systems team that completes the loading and maintenance of payors and pricing in the billing system (CPR+)
- Oversees the systems team that manages the CPR+ admin duties including user privileges, popup menus, company, and site setup
- Oversees the systems team that manages the clearing house (Zirmed) admin duties including user privileges, payor setup, payor rejections, patient statements
- Assist with identification of internal system load issues and provide guidance to the Systems Analyst team on potential corrections
- Reads and interprets payor contract and amendment language to identify required, acceptable, and unacceptable contract terms
- Consults with Operations, Sales, Managed Care, Revenue Cycle Management, and Legal regarding questionable contract language
- Coordinates language review with Financial Planning and Analysis department review of payor pricing
- Provides payer negotiation support to Managed Care
- Provides ongoing support to Intake and operations to ensure that provider profiles are loaded correctly and remain up to date to reflect correct network status on benefit verification calls
- Reviews discrepancies from Intake verification calls to identify contract limitations or issues requiring payor intervention for correction
- Provides Intake with interpretation of payor guidelines and policies as needed to ensure appropriate acceptance or rejection of complex referrals
- Provides ongoing interpretation of contracts and payor guidelines to Billing to ensure claims are submitted accurately
- Provides ongoing interpretation of contracts and payor guidelines to Collections to assist with effective resolution of open balances
- Assists with auditing of credit balances to identify and correct overpayment trends
- Takes adjustments for payments that are correct based on the contract and payor policies
- Assists with auditing of open balances to identify denial trends or consistent payment delays
- Reviews submitted adjustments to verify accuracy and identify possible claims trends requiring payor intervention
- Assists Collections with “root cause analysis” to identify and correct the sources for claims trends through clean claims analysis and by other means
- Coordinates claims projects and discrepancy escalation with Managed Care as assigned
- Other duties as assigned

**Qualifications**
- Minimum three (3) year experience, preferred
- A minimum of two (2) years of experience reading and interpreting contract language, preferably in a healthcare-related field, required
- Working knowledge of Commercial and Government healthcare reimbursement
- Solid Microsoft Office Skills required: Word, Excel, and Outlook
- Excellent verbal and written communication skills
- Excellent organizational skills and attention to detail
- Basic understanding of or ability to quickly learn company product codes and terminology
- Thorough understanding of RCM/Contacting department policies and procedures
- Strong analytical skills and ability to make sound judgments relative to the RCM/Contracting
- Ability to independently research and interpret information
- Strong organizational skills and attention to detail

**Additional Information**
Conduct visits to area training schools to determine contractual compliance & audit training provider.

Review documentation for training milestones as per contractual training vouchers.
- Equus Workforce Solutions is a leading provider of workforce development services in North America. With a dedicated and passionate team, Equus puts the industry’s best practices to work by focusing on the development, design, and delivery of demand-driven workforce solutions._
- When you join Equus, you can expect extensive learning opportunities and networking programs. But most of all you can expect to make a lasting impact on the lives of others._
- At Equus we are strengthened by diversity. We are committed to providing a work environment in which everyone is included, treated fairly and with respect. Equus Workforce Solutions is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, age, pregnancy, sexual orientation, gender identity, ancestry, reli

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