Managed Care Contract Analyst

3 weeks ago

Louisville, United States Commonwealth Pain and Spine Full time

Commonwealth Pain & Spine (CP&S) is one of the fastest growing, progressive, comprehensive pain management groups in Kentucky and Southern Indiana. Our team of friendly physicians are all board certified in pain medicine and anesthesiology and take the time to educate our staff. Our facilities are brand new with the latest technology. We have a team/family-oriented culture with great hours, competitive pay, benefits, and open interaction between our staff and management.

This position has the opportunity to become hybrid with a mix of working in the office and remotely.

The Analyst is responsible for developing proactive solutions for managed care contracts. Serves as a lead and data expert for implementation, dashboards pertaining to managed care contracting and performance outcome success. This position will update the dashboard, validate data, and forecast performance reporting and functionality. This position represents both internal and external progress, incentives and initiatives in their area as well as educating and training internal and external stakeholders on the organization's system wide initiatives.

Key Responsibilities:

  • Assist in tracking and trending contract issues.
  • Possess extensive knowledge of payor contracts and policies.
  • Identify variances, trends, and contracting omissions.
  • Create and maintain detailed reports and review with Director of Contracting
  • Assist in assessing and analyzing current payor contracts for areas of improvement and contract maximization during contract negotiation.
  • Review and present findings, solutions, and recommendations Director of Contracting and Credentialing.
  • Memorize and comprehend contract terms, renewal and end dates, or other time-sensitive information.
  • Analyze coding, reimbursement hierarchy, interpret verbiage and contract language intent.
  • Research and variance recovery, global trends of variances, and contact payors to recover underpayments.
  • Maintain systems and track variance statistics.
  • Analyze relevant data to provide reports, which includes determining the impact of adjustments to managed care reimbursement terms and/or contract compliance, along with rate modeling necessary for contract negotiations.
  • Collaborate with Payment Specialist team to determine accuracy of insurance payments.
  • Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct payments.
  • Manages and maintains charge master.
  • Performs other duties, as assigned.
  • All other duties assigned including duties performed for affiliates, assigns, lessees, contractors or other third parties
Requirements

Required Skills:
  • Strong organizational skills and demonstrated ability to work independently and prioritize responsibilities.
  • Adheres to all patient confidentiality policies and carries out all tasks in a pleasant and respectful manner.
  • Knowledge of industry-specific terminology, billing and collections principles and best practices with complete understanding of relevant laws, rules, and regulations
  • This position requires the use of critical thinking skills to interpret complex managed care contracts to maintain the Contract Management System and ensure estimated reimbursement is calculating maximum and correct reimbursement.
Education & Experience:
  • Bachelor's degree preferred.
  • 3-5 years of Managed Care or contracting experience required.
  • Knowledge of CPT coding
  • If required to travel for company related purposes:
  • Active, valid driver 's license
  • State minimum coverage vehicle insurance
  • Must be able to pass driving history/motor vehicle check upon hire and maintain an acceptable record thereafter
  • Maintain status as an "approved driver" through the HR department, including submitting required documentation before expiration
Benefits:
  • Competitive compensation
  • License and DEA Reimbursement
  • Annual Education/CME reimbursement
  • Comprehensive Health/Vision/Dental insurance options
  • Great PTO plan PLUS Paid Holidays
  • 401k and matching available

Commonwealth Pain and Spine is an Equal Employment Opportunity Employer

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