Payer Contract Analyst

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

📋 Description

• Assist the revenue cycle management team with complex billing and collection challenges.

• Support network contracting through payer communications, follow-up assistance, and documentation tasks.

• Keep payer contract requirements updated and maintain pharmacy electronic records.

• Aid in activities related to payer negotiations.

• Address inquiries regarding contracts, reimbursement, benefit design, and contracted services.

• Oversee payer processes to ensure adherence to policies and procedures.

• Offer expertise on requirements, rules, and regulations pertaining to third-party and government payers.

• Comprehend eligibility and authorization prerequisites for insurance plans, Medicare, and Medicaid.

• Update contract folders and complete contract cover sheets along with special projects.

• Manage processes and databases, including updates to contracts and fee schedules, for tracking, audits, reporting, analysis, and prompt resolution.

• Take on regularly scheduled revenue cycle reports and assist in the creation of new reports.

• Help with requests related to drug profitability.

• Accurately and promptly complete assigned tasks and projects.

• Perform additional duties as required.

⛳️ Requirements

• High school diploma or GED is mandatory.

• A minimum of 3 years of experience in Home Infusion is required.

• Familiarity with reimbursement practices and electronic claims processing is essential.

• Prior experience in pharmacy and health insurance is preferred.

• Basic understanding of contracts, third-party insurance, HIPAA, Medicare, and Medicaid is necessary.

• Strong grasp of payer contracting and managed care programs.

• Significant experience with reporting, Excel, BI, and data flows.

• Exceptional interpersonal, organizational, communication, and problem-solving skills.

• High attention to detail is crucial.

• Capability to manage multiple projects at once.

• Ability to work independently or as part of a team when necessary.

• Effective communication skills are required.

• Discretion in managing sensitive company information is essential.

• Proficiency in Microsoft Office software is necessary.

• Experience with Power BI is preferred.

• For remote work, a cable broadband or fiber optic internet connection with a minimum of 10 Mbps download and 5 Mbps upload is required.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical insurance coverage.

• Vision insurance options.

• Dental insurance benefits.

• Access to well-being and behavioral health programs.

• Participation in a 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement assistance.

• A minimum of 18 days of paid time off annually.

• Paid holidays.

• Leaves of absence available.

• Requirement for cable broadband or fiber optic internet service for remote work.