Managed Care Contract Analyst

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

📋 Description

• Assist in formulating managed care contracting strategies for Obtelecare programs.

• Perform research on payers and monitor contracting opportunities.

• Aid in the execution of contracts and the upkeep of agreements.

• Analyze, interpret, and summarize payer agreements, reimbursement terms, billing requirements, credentialing requirements, payer enrollment specifics, state-specific provisions, and contract notice provisions.

• Assess fee schedules, reimbursement terms, payer behavior, underpayments, trends, and variances.

• Keep updated contract summary sheets, fee schedule crosswalks, payer lists, rosters, contract status reports, workflow metrics, and additional contracting documentation.

• Collaborate with Revenue Cycle Management, operations, credentialing, payer enrollment, and payer representatives to address escalated claims, reimbursement, and contract interpretation challenges.

• Generate ad-hoc reports and data analyses concerning payment trends, denials, payer performance, reimbursement variances, and contract-related opportunities.

• Maintain training materials, reference documents, and process guides related to contracts.

• Securely handle contract documentation, payer information, and Protected Health Information as per company policies and regulatory standards.

⛳️ Requirements

• At least 5 years of experience in managed care contracting, payer relations, provider relations, revenue cycle, or healthcare contracting.

• Strong knowledge of Revenue Cycle Management, managed care contract language, reimbursement methodologies, payer operations, contract interpretation, and healthcare regulatory considerations.

• Capability to analyze intricate payer agreements, pinpoint reimbursement or process improvement opportunities, investigate payer issues, and propose solutions.

• Exceptional analytical, organizational, communication, documentation, and follow-up skills with a keen attention to detail.

• Proficiency in Microsoft Word, Excel, and contract or revenue cycle systems.

• A Bachelor’s degree in business administration, accounting, finance, healthcare, or a related field is preferred; equivalent work experience may be taken into account.

• Experience in healthcare analytics, contract modeling, reimbursement analysis, reporting tools, ECHO, data warehouse reporting, or advanced Excel is advantageous.

• Ability to manage contract documentation, payer information, and Protected Health Information securely in accordance with company policies and regulatory guidelines.

🏝️ Benefits

• Full-time, eligible for benefits.

• Paid time off and holidays.

• Medical, dental, and vision insurance.

• Health Savings Account with employer contribution.

• Flexible Spending Account options.

• Employer-funded basic life and AD&D insurance.

• Employer-funded short- and long-term disability.

• Optional short-term disability buy-up plan.

• Paid parental leave.

• 401(k) savings plan with matching contributions.

• Legal plan and identity theft protection services.

• Mental health support and resources.

• Mission-driven company culture.

• Occasional travel may be necessary for meetings, training, or business requirements.