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Nashville, Tennessee, United States Wellpath Full time{"title": "Pricing Analyst", "content": "About the RoleWe are seeking a skilled Pricing Analyst to join our team at Wellpath. As a Pricing Analyst, you will play a critical role in developing estimates of cost elements and pricing for contract proposals, contract amendments, contract renewals, and new business ventures.Key ResponsibilitiesPrepare...
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Business Analyst
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Managed Care Contract Analyst
4 months ago
Job Purpose: Contract Analyst will be responsible for analytic support related to ION network and providers. Team member will work closely with the Managed Care department team in generating and reviewing system data, while making strategic recommendations. The role includes loading and maintaining reimbursement rates in ION contract management system. Additional responsibilities include collaborating with other internal teams with reimbursement related concerns and acting as a liaison to managed care plans. Essential Functions: · Support Managed Care team with matters relating to external providers, plan sponsors regulatory agencies, managed care payers, and the community. · Load contracted rates into contract management system. · Analyze relevant data to provide in 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 reimbursement analytic team to determine accuracy of insurance payments. · Create presentation materials for internal and external meetings. · Act as business liaison to assigned business unit meetings and committees, which includes presenting and discussing new subject matter. · Identify and recommend improvements in processes for greater operational efficiency. · Maintain various department spreadsheets and databases. · Review managed care payer contracts with a focus on interpreting and implementing reimbursement terms in a multi-functional approach to Managed Care strategies. · Assume other projects and assigned job duties related to managed care, as needed. · Auditing contracts to ensure proper payment in the Experian tool. · Working with payers to resolve contract loading errors identified from audits. · Work in underpayment tool to appeal claims and recoup underpaid claims not paid according to the agreement. Qualifications: · Education: Bachelor’s Degree or equivalent experience · Skills: Health care reimbursement experience in a health system, consulting firm, or with a managed care payer preferred. Knowledge of basic Microsoft Office tools required. Ability to work individually and in a team setting. Strong communication skills are necessary. · Years of Experience: 1-2 in Managed Care + contract negotiating experience with managed care payers. Preferred Qualifications: · Skills: Advanced knowledge of Microsoft Office tools · Years of Experience: 3+ in Managed Care Physical Demands and work environment The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying ten pounds maximum, seeing, speaking and hearing. Work environment: Required job duties are normally performed in a climate-controlled office environment.
