Business Analyst- Provider Contract - Franklin, United States - Sierra Solutions Group

Description

Job Summary
We are seeking a highly skilled Provider Contract Business Analyst with expertise in Provider Reimbursement Contracts and Medicare/Texas Medicaid Guidelines for our Healthcare technology client. In this role, you will play a critical part in the review of Provider Contracts, Medicare/TX Medicaid Reimbursement Guidelines, and translate provider reimbursement contract language from a contract to a configuration template. You will be responsible for ensuring the Provider Reimbursement Contracts do not miss any important details. You will also be responsible for ensuring the Configuration Templates are complete and include any specific federal/state guidelines that may not be called out in the provider contract. Your work will be pivotal in ensuring the provider contracts are set up correctly in the payer platform based on the interruption of the provider contract and federal/state guidelines. This is a new position, so you will be responsible for getting this new initiative off the ground and eventually leading/training others on the initiative.

Primary Responsibilities

• Review provider paper reimbursement contracts for accuracy and completeness.
• Interpret provider reimbursement contracts/language into configurable requirements.
• Review Medicare/Texas Medicaid reimbursement guidelines to add to configurable requirements.
• Work with the Provider Contracting/Network team and the Configuration team to ensure contracts are configured per the provider reimbursement contract and Medicare/Medicaid guidelines.
• Review/monitor provider fee schedules for accuracy.
• Determine if the provider paper reimbursement contract is missing any important information needed to configure the payor platform.
• Provide medical coding for specific services called out in provider contracts.
• Write configuration templates based on provider contract language and regulatory guidelines.

Education and Experience

• Overall experience of around 6-8 years reviewing provider paper contracts and reimbursement language.
• Familiar with different provider reimbursement types.
• Knowledge of Medicare reimbursement guidelines.
• Knowledge of Medicaid reimbursement guidelines.
• Ability to be a self-starter and lead other team members.
• Able to work well with others.
• Analytical.
• Strong problem-solving skills and a proactive attitude.
• Excellent communication and teamwork skills.