Contract Resolution Specialist

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Support network providers with contractual challenges.

• Serve as a trainer and educator on CoxHealth Network contracts for network providers and their teams.

• Coordinate and facilitate meetings as necessary.

• Conduct initial and recredentialing on-site assessments and chart reviews for providers as required.

• Address contract issues and deliver, as well as interpret, policy and procedure modifications related to specific contracts.

• Communicate any regulatory updates related to the insurance sector as needed.

• Investigate new technologies connected to payors' medical necessity and coverage.

• Maintain relationships and provide educational resources to network, tertiary/affiliate PHO networks affecting over 3,000 providers and facilities.

• Organize, prioritize, and manage multiple tasks to effectively carry out projects and daily operations.

⛳️ Requirements

• High School Diploma or Equivalent.

• 3-5 years of experience in a provider office, healthcare billing, healthcare insurance, and/or Managed Care industry.

• Ability to comprehend complex multi-provider payor contract agreements and ensure compliance standards are met.

• Must be a self-motivated individual capable of working with minimal oversight.

• Extensive knowledge of managed care plans and CoxHealth contracts.

• Understanding of the legality surrounding the messenger process utilized for independent providers.

• Capability to analyze and convey contractual terms and obligations to providers.

• Local travel is required.

• Preferred: Bachelor's degree in a related field.

• Preferred: Prior experience in provider relations and/or management of a physician's office.

🏝️ Benefits

• Medical, Vision, Dental.

• Retirement plan with Employer Match.

• Benefits eligibility for employees working 20 or more hours per week.