Reimbursement and Contracts Specialist

3 weeks ago

San Diego, California, United States PROMETHEUS LABORATORIES INC Full time
Job Description

Prometheus Laboratories Inc. is seeking a skilled Reimbursement and Contracts Specialist to support the Health Systems, Market Access, Payor Relations, and Legal teams. This role will involve managing contracts, facilitating communication between teams, and ensuring that contracts are processed and documented appropriately.

Key Responsibilities:

  • Assist with drafting contracts, including amendments for Laboratory Pricing Agreements and Specimen Handling Agreements.
  • Facilitate communication between teams to address contract-related questions or issues and streamline the contract management process.
  • Work closely with Health Systems team and Sales Leadership to refine the customer contract pipeline and ensure appropriate lead time for renewal and other contracting needs.
  • Triage and communicate appropriate pricing modifications to existing contracts and ensure that pricing modifications are accurate according to the requirements.
  • Maintain contract databases, ensuring that all information is up to date, accurately recorded, and timely.
  • Manage client account configurations from Laboratory Systems and Billing Systems, up to, and including, Account creating and pricing configurations.
  • Ability to analyze and report out insights gathered from reimbursement data and cash collections.
  • Experience in translating raw data into meaningful information and explaining data to management teams when necessary.
  • Proactive tracking and trending of data to help identify shifts in business activities related to Revenue Cycle and payments.
  • Assist with the review, preparation and tracking of credentialling for all field sales team members.
  • Conduct ad-hoc contract analysis in conjunction with Prometheus' Sales Operations teams.
  • Generate pricing simulations and workbooks in support of contracting initiatives.
  • Provide support and guidance to department teams on contract-related matters.
  • Identify and recommend improvements to Contract Management and workflow applications.
  • Analyzes data to identify and solve operational issues and refine the experience.
  • Develops professional relationships with internal customers (and external customers, where appropriate), maintains open lines of communication and builds rapport by providing timely and professional service.
  • Continues to develop skills and build collections knowledge and business acumen.
  • Monitor email, phone and fax system to collect incoming payment info, billing requests, etc.
  • Reconciled weekly accounts to validate invoices are priced per contracted rates.

Requirements:

  • Bachelor's degree in related field.
  • 1-2 years prior experience managing contracts.
  • 1-2 years prior experience with reimbursement in the clinical laboratory or other related healthcare organizations.
  • Proficiency in Microsoft Office Applications (MS Word, MS Excel, MS PowerPoint).
  • Experience with Salesforce.com, Conga CMS, and XIFIN is a plus.
  • Proficient in MS office, excel and related billing systems.
  • Ability to think logically in following procedures and instructions.
  • Ability to self-direct confidently in the absence of defined/detailed instructions.
  • Ability to follow-up timely and thoroughly on outstanding tasks.
  • Ability to work in a fast-paced environment.
  • Ability to multi-task.
  • Highly organized.
  • Extremely detail oriented.

Language Skills:

Must be fluent in both verbal and written English. Must have the ability to speak effectively to provide information and respond to questions from client customers, managers, and employees. Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to provide analysis, summarize data, write reports, business correspondence, and procedure documents. Ability to effectively present information and respond to questions from groups of managers, co-workers, and clients.

Mathematical Skills:

Ability to audit, calculate, estimate and propose figures and amounts such as discounts, interest, proportion, averages and percentages.

Reasoning Ability:

Ability to apply common sense understanding to carry out directives and follow instructions furnished in written, oral, or diagram form. Ability to deescalate and deal with problems involving upset customers and stressful situations. Ability to understand and appreciate HIPAA rules and regulations regarding patient privacy.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually quiet.

All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status or other protected class.

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