Contract Specialist - New York, United States - ConnectiCare
Description
Summary of PositionRoles and Responsibilities
- Participate in all aspects of provider, facility, and ancillary rate configurations in Network within set deadlines, while ensuring full accuracy of contract loads.
- Collaborate with Network Management and Analytics to ensure proper capture of negotiated and modeled contractual agreements.
- Identify and correct rate load problems.
- Assist with the contract configuration, fee schedule / grouper, and rate reimbursement matters.
- Analyze negotiated contracts to determine Network interaction with the core systems ensuring that reimbursement is in line with negotiated intent.
- In coordination with Network Management, update all evergreen contracts in a timely manner.
- Recommend contract language changes to be in line with system reimbursement capabilities.
- Coordinate rate testing with BTS.
Qualifications:
- B. S. degree in Business Operations, Information Systems or equivalent
- Master's Degree a plus but not required
- Minimum 23 years of relevant experience, preferably in a healthcare environment required
- Experience in provider, facility, and ancillary contract files setups, maintenance, testing and auditing functions required
- Experience in establishing and accomplishing business strategies to successfully translate contractual language into system reimbursement specifications required
- Excellent knowledge of medical terminology, Fee Schedules, and ICD/CPT/HCPCS coding required
- Understanding of Government reimbursement methodologies required
- Analytic, problem solver, excellent organizational and technical skills and attention to detail are required
- Job Type: Standard
- Schedule: Fulltime
- Employee Status: Regular
- Requisition ID:
- Hiring Range: $45,000$77,000
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