Payer Contract Analyst

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

📋 Description

• Assist the Revenue Cycle Management team in addressing escalated systemic billing and collection challenges.

• Provide support for network contracting by engaging in payer calls, follow-ups, and necessary documentation.

• Ensure compliance with payer contract stipulations while keeping contracts current in pharmacy electronic files.

• Participate in payer negotiation efforts.

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

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

• Act as a subject matter expert on the requirements, rules, and regulations of third-party and government payers.

• Comprehend insurance eligibility and authorization prerequisites, including Medicare and Medicaid reimbursement guidelines.

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

• Maintain contract and fee schedule databases for tracking, audits, reporting, analysis, and prompt resolution.

• Take on regularly scheduled Revenue Cycle Analyst reports and contribute to the development of new reports.

• Assist with requests related to drug profitability.

• Ensure all assigned projects are completed accurately and punctually.

• Execute other duties as required.

⛳️ Requirements

• A high school diploma or GED is mandatory.

• Minimum of 5 years of experience in Home Infusion is required.

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

• Experience in pharmacy and health insurance related to contracts, third-party insurance, HIPAA, Medicare, and Medicaid is preferred.

• In-depth knowledge of payer contracting and managed care programs is essential.

• Strong reporting skills using Excel, BI, and Data Flows are required.

• Excellent interpersonal, organizational, communication, and problem-solving abilities.

• Keen attention to detail is necessary.

• Capability to manage multiple projects concurrently.

• Ability to work independently or as part of a team based on project requirements.

• Effective communication skills are essential.

• Discretion in managing confidential company information is necessary.

• Ability to approach problem-solving in an effective manner.

• Proficiency in Microsoft Office applications is required.

• Experience with Excel and Power BI is preferred.

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

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical benefits commence on day one.

• Vision benefits available starting on day one.

• Dental benefits effective from day one.

• Access to well-being and behavioral health programs from day one.

• 401(k) plan available.

• Company-covered life insurance.

• Tuition reimbursement offered.

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

• Paid holidays provided.

• Leaves of absence available.

• Opportunity for remote work arrangements.