Business Analyst- Provider Contract

2 weeks ago


Franklin, United States Sierra Solutions Group Full time

Job Summary

We are seeking a highly skilled Provider Contract Business Analyst with expertise in Provider Reimbursement Contracts and Medicare/Texas Medicaid Guidelines for our Healthcare technology client. In this role, you will play a critical part in the review of Provider Contracts, Medicare/TX Medicaid Reimbursement Guidelines, and translate provider reimbursement contract language from a contract to a configuration template. You will be responsible for ensuring the Provider Reimbursement Contracts do not miss any important details. You will also be responsible for ensuring the Configuration Templates are complete and include any specific federal/state guidelines that may not be called out in the provider contract. Your work will be pivotal in ensuring the provider contracts are set up correctly in the payer platform based on the interruption of the provider contract and federal/state guidelines. This is a new position, so you will be responsible for getting this new initiative off the ground and eventually leading/training others on the initiative.

Primary Responsibilities

Review provider paper reimbursement contracts for accuracy and completeness.

Interpret provider reimbursement contracts/language into configurable requirements.

Review Medicare/Texas Medicaid reimbursement guidelines to add to configurable requirements.

Work with the Provider Contracting/Network team and the Configuration team to ensure contracts are configured per the provider reimbursement contract and Medicare/Medicaid guidelines.

Review/monitor provider fee schedules for accuracy.

Determine if the provider paper reimbursement contract is missing any important information needed to configure the payor platform.

Provide medical coding for specific services called out in provider contracts.

Write configuration templates based on provider contract language and regulatory guidelines.

Education and Experience

Overall experience of around 6-8 years reviewing provider paper contracts and reimbursement language.

Familiar with different provider reimbursement types.

Knowledge of Medicare reimbursement guidelines.

Knowledge of Medicaid reimbursement guidelines.

Ability to be a self-starter and lead other team members.

Able to work well with others.

Analytical.

Strong problem-solving skills and a proactive attitude.

Excellent communication and teamwork skills.

#J-18808-Ljbffr



  • Franklin, United States CareerBuilder Full time

    Overview The Data & Business Systems Analyst III works with the Data Services team and is a blend of the roles of business systems analyst, business data analyst, and data evangelist. Highlights include user story development, data visualization, identifying insights, certifying data sources, and regularly engaging internal customers, encouraging them in the...


  • Franklin, United States CareerBuilder Full time

    Job Summary We are looking for a QNXT Configuration Analyst for our Healthcare Technology client. As a QNXT Configuration Analyst, you will be responsible for configuring and maintaining the QNXT system to meet the business needs of the healthcare organization. You will work closely with the IT team and cross-functional departments to ensure the system is...

  • Data Analyst

    1 day ago


    Franklin, United States Epsilon Full time

    Job Description We are looking for a highly motivated, detail-oriented business intelligence analyst with excellent SQL skills and experience working with large datasets. As a Data Analyst, you will be integral in developing the processes and data visualization to provide in-depth analysis and advance reporting for retail media campaigns. A strong candidate...


  • Franklin Park, United States RCM Technologies Full time

    Job Title: Application Support Analyst ERP Job Function: Application Support for Epicor ERP or other ERP Applications Job Type: Full time direct hire, but contract to hire may be consideredLocation: Hybrid St. Joseph, MI or Chicago, IL Scope of JobThe Application Support Analyst will provide general application support (access, issues, and ad hoc requests)...

  • Senior Tax Analyst

    2 weeks ago


    Franklin, United States Alari Search, LLC Full time

    Job DescriptionJob DescriptionThe Senior Tax Analyst position's main responsibilities include preparing schedules for tax provisions, quarterly estimated tax, and corporate income tax filings. The Senior Tax Analyst is responsible for assisting with corporate income tax matters, income tax returns compliance processes, researching tax issues, analyzing...

  • Compliance Analyst

    1 day ago


    Franklin, United States Creative Financial Staffing Full time

    COMPLIANCE ANALYSTAbout the Opportunity: CFS is working with our client in Franklin, TN to locate a Compliance Analyst as their Risk & Compliance team is growing! This opportunity is hybrid, and the environment is business casual.8:00 - 5:00 and Hybrid Schedule The Compliance Analyst is responsible for ensuring adherence with reporting, audits, and...

  • Compliance Analyst

    1 week ago


    Franklin, United States Creative Financial Staffing Full time

    COMPLIANCE ANALYST About the Opportunity: CFS is working with our client in Franklin, TN to locate a Compliance Analyst as their Risk & Compliance team is growing! This opportunity is hybrid, and the environment is business casual. 8:00 - 5:00 and Hybrid Schedule The Compliance Analyst is responsible for ensuring adherence with reporting, audits, and...


  • Franklin Lakes, United States Stellar Consulting Solutions, LLC Full time

    Job Title: Analyst - Security AnalyticsLocation : Franklin lakes, NJ (Hybrid preferred 3 days)Contract (W2) with Direct ClientSummary:Analysts within Security Analytics define, develop and implement cyber monitoring use cases in the security monitoring solutions, maintain high availability of monitored attack surface, and engage in and support advanced...

  • Senior Security Analyst

    Found in: Appcast US C2 - 1 week ago


    Franklin Lakes, United States Stellar Consulting Solutions, LLC Full time

    Job Title: Analyst - Security AnalyticsLocation : Franklin lakes, NJ (Hybrid preferred 3 days)Contract (W2) with Direct ClientSummary:Analysts within Security Analytics define, develop and implement cyber monitoring use cases in the security monitoring solutions, maintain high availability of monitored attack surface, and engage in and support advanced...

  • Senior Security Analyst

    Found in: Appcast Linkedin GBL C2 - 1 week ago


    Franklin Lakes, United States Stellar Consulting Solutions, LLC Full time

    Job Title: Analyst - Security AnalyticsLocation : Franklin lakes, NJ (Hybrid preferred 3 days)Contract (W2) with Direct ClientSummary:Analysts within Security Analytics define, develop and implement cyber monitoring use cases in the security monitoring solutions, maintain high availability of monitored attack surface, and engage in and support advanced...

  • Compliance Analyst

    5 days ago


    Franklin, United States Creative Financial Staffing Full time

    COMPLIANCE ANALYST About the Opportunity: CFS is working with our client in Franklin, TN to locate a Compliance Analyst as their Risk & Compliance team is growing! This opportunity is hybrid, and the environment is business casual. 8:00 - 5:00 and Hybrid Schedule The Compliance Analyst is responsible for ensuring adherence with reporting, audits, and...


  • Franklin Park, United States RCM Technologies Full time

    Job Title: Application Support Analyst ERP Job Function: Application Support for Epicor ERP or other ERP Applications Job Type: Full time direct hire, but contract to hire may be considered Location: Hybrid St. Joseph, MI or Chicago, IL Scope of Job The Application Support Analyst will provide general application support (access, issues, and ad hoc...

  • Integration Analyst

    2 weeks ago


    Franklin, United States Summit BHC Full time

    Integration Analyst - Corporate | Summit Healthcare Mgmt | Franklin, Tennessee About the Job: Under the direction of the Senior Director of Applications, the Integration Analyst is responsible for establishing and maintaining integration among the company's suite of applications. This entails implementation, testing, and support of various integration points...

  • Sr. Data Analyst

    Found in: beBee S US - 2 weeks ago


    Franklin, United States Nissan Motor Corporation Full time

    With a focus on Mobility, Operational Excellence, Value to our Customers and the electrification of vehicles, you can expect to be part of something exciting. From the sleek design of our vehicles to the unique opportunities we offer around the globe, Nissan exemplifies ingenuity in everything we do. Our people are what drive the business forward. The Data...


  • Franklin Lakes, United States MILLENNIUMSOFT Full time

    Job Description Job Description Description: Flex New Hire EDUCATION Bill rate $110 preferred 3 days/week onsite, however will consider strong remote individual Analyst - Security Analytics As an analyst on our Security Analytics team, you will play a pivotal role in enhancing our organization's security posture. This role requires a blend of technical...

  • IT Data Analyst

    Found in: beBee S US - 3 weeks ago


    Franklin, United States OPT Nation Full time

    The IT Data Analyst works with IT and business stakeholders to identify processes and solutions to combine and normalize information from many disparate sources. This position improves data quality and consistency supports program data requirements by analyzing process controls creates common vocabulary and performs root cause analyses.Essential Job...

  • Help Desk Analyst

    Found in: beBee S US - 3 weeks ago


    Franklin, United States Soft Labs NA Inc Full time

    SummaryThe FAMC Help Desk Analyst will support the Identity and Access Management’s (IAM) Access Provisioning team at Franklin American Mortgage Company. IAM is a group within the Corporate Security & Resilience (CS&R) organization. The IAM group provides subject matter expertise and associated security services to the business division across the...


  • Franklin Lakes, United States MillenniumSoft Inc Full time

    Job DescriptionJob DescriptionDescription: Flex New Hire EDUCATION Bill rate $110 preferred 3 days/week onsite, however will consider strong remote individual Analyst - Security Analytics As an analyst on our Security Analytics team, you will play a pivotal role in enhancing our organization's security posture. This role requires a blend of technical...

  • PMO Project Analyst

    2 days ago


    Franklin Lakes, United States Becton, Dickinson & Company Full time

    The Project Analyst is responsible for collaborating with cross functional teams and ensuring the success of a major, multi-year, multi-faceted and highly complex program within the Medication Delivery Solutions (MDS) business at BD. We are seeking a Project, Analyst, Manufacturing, Business Services, Support


  • Franklin Lakes, United States Indotronix Avani Group Full time

    Job Title: Security Analyst CFNJP00048323 W2 Only preferred 3 days/week onsite Franklin Lakes, however will consider strong remote individual Analyst - Security Analytics As an analyst on our Security Analytics team, you will play a pivotal role in enhancing our organization's security posture. This role requires a blend of technical expertise, analytical...