Ob Hospitalist Group
Managed Care Contract Analyst/Provider Relations
Ob Hospitalist Group, Greenville, South Carolina, us, 29610
Managed Care Contract Analyst Position Summary:
Provides support to the Manager of Managed Care Contracting. Primary responsibilities include: obtaining payor contacts and reviewing & understanding the contract terms and responsibility of the group; performing fee schedule analysis and acting as the point of contact for RCM billing questions.
Managed Care Contract Analyst Essential Responsibilities:Coordinate with Manager of Managed Care Contracting to develop and implement a network development strategy for existing or new programs. Research payors and complete necessary payor follow-up to obtain agreements and/or linking the location to any existing agreements.Summarize the Agreement by completing the contract summary sheet with all relevant information from the contract language, payer contract representative, and or payer website. This includes gathering Health Plan Contact Information, Credentialing & Enrollment requirements and other pertinent information that is needed by RCM to administer the agreement.Fee Schedules: determine if the fee schedule for the plan is appropriate for the state or region that the plan covers. Maintain these fee schedules in ECHO and in excel. Update fee schedules based on current year annually. Load fee schedules in the CHC variance tool, identify trends, review, and research variances. Follow-up with the payor as appropriate to obtain additional reimbursement.Leads ongoing maintenanceand auditing of contract management rate calculationsMakes independent decisions on contracting rates for new agreements and or renegotiated agreements based on existing rate information.Link new locations/programs to existing state contracted payors as needed.Develop and maintain Echo Reports including rosters, Onboarding Report and Payer lists by state, including coordinating with the vendor when needed.Maintain training material for new hires.Responsible for maintaining contracting files, including maintenance of the OBHG contracting database.Develop and maintain reports and/or spreadsheets to document contracting leads and workflow.Be the point of contact when the RCM has issues with any Health Plan/Payer. Responsible for making independent decisions and coordinating with the Health Plan to assist with resolution of any escalated claims issues.Completes other projects as assigned.Ensure all Protected Health Information is always kept in a secure location.Essential Skills/Credentials/Experience/Education
5+ years managed care contracting/provider relations experience in healthcare.Strong Revenue Cycle Management Analytical and Reporting SkillsGeneral knowledge of Revenue Cycle Management as it pertains to Accounts Receivable, Credentialing and EDI/EFT.Knowledge of contracting language and the principles of negotiation.Strong understanding of Managed Care, Credentialing and Accounts Receivable.Strong critical thinking skills and ability to identify process improvement possibilitiesStrong organizational skills and attention to detail.Strong computer skills, proficient in Word & Excel.Preferred Skills/Credentials/Experience/Education
Bachelor's degree in business administration, accounting, finance, healthcare or related field and/or equivalent work experience.Familiarity with managed care, State and/or Federal health care programsPrevious history of analytics experienceMental and Physical Demands (per ADA guidelines)
Physical Demands: Sitting for long periods of time. Occupation requires this activity more than 66% of the time (5.5+ hrs/day)
Annual Compensation Range:
$60,000 -$70,000
What We Offer - The Good Stuff:
A mission based company with an amazing company culture.Paid time off & holidays so you can spend time with the people you love.Medical, dental, and vision insurance for you and your loved ones.Health Savings Account (with employer contribution) or Flexible Spending Account options.Paid Parental LeaveEmployer Paid Basic Life and AD&D Insurance.Employer Paid Short- and Long-Term Disability.Optional Short Term Disability Buy-up plan.401(k) Savings Plan, with ROTH option.Legal Plan.Identity Theft Services.Mental health support and resources.Employee Referral program - join our team, bring your friends, and get paid.
Provides support to the Manager of Managed Care Contracting. Primary responsibilities include: obtaining payor contacts and reviewing & understanding the contract terms and responsibility of the group; performing fee schedule analysis and acting as the point of contact for RCM billing questions.
Managed Care Contract Analyst Essential Responsibilities:Coordinate with Manager of Managed Care Contracting to develop and implement a network development strategy for existing or new programs. Research payors and complete necessary payor follow-up to obtain agreements and/or linking the location to any existing agreements.Summarize the Agreement by completing the contract summary sheet with all relevant information from the contract language, payer contract representative, and or payer website. This includes gathering Health Plan Contact Information, Credentialing & Enrollment requirements and other pertinent information that is needed by RCM to administer the agreement.Fee Schedules: determine if the fee schedule for the plan is appropriate for the state or region that the plan covers. Maintain these fee schedules in ECHO and in excel. Update fee schedules based on current year annually. Load fee schedules in the CHC variance tool, identify trends, review, and research variances. Follow-up with the payor as appropriate to obtain additional reimbursement.Leads ongoing maintenanceand auditing of contract management rate calculationsMakes independent decisions on contracting rates for new agreements and or renegotiated agreements based on existing rate information.Link new locations/programs to existing state contracted payors as needed.Develop and maintain Echo Reports including rosters, Onboarding Report and Payer lists by state, including coordinating with the vendor when needed.Maintain training material for new hires.Responsible for maintaining contracting files, including maintenance of the OBHG contracting database.Develop and maintain reports and/or spreadsheets to document contracting leads and workflow.Be the point of contact when the RCM has issues with any Health Plan/Payer. Responsible for making independent decisions and coordinating with the Health Plan to assist with resolution of any escalated claims issues.Completes other projects as assigned.Ensure all Protected Health Information is always kept in a secure location.Essential Skills/Credentials/Experience/Education
5+ years managed care contracting/provider relations experience in healthcare.Strong Revenue Cycle Management Analytical and Reporting SkillsGeneral knowledge of Revenue Cycle Management as it pertains to Accounts Receivable, Credentialing and EDI/EFT.Knowledge of contracting language and the principles of negotiation.Strong understanding of Managed Care, Credentialing and Accounts Receivable.Strong critical thinking skills and ability to identify process improvement possibilitiesStrong organizational skills and attention to detail.Strong computer skills, proficient in Word & Excel.Preferred Skills/Credentials/Experience/Education
Bachelor's degree in business administration, accounting, finance, healthcare or related field and/or equivalent work experience.Familiarity with managed care, State and/or Federal health care programsPrevious history of analytics experienceMental and Physical Demands (per ADA guidelines)
Physical Demands: Sitting for long periods of time. Occupation requires this activity more than 66% of the time (5.5+ hrs/day)
Annual Compensation Range:
$60,000 -$70,000
What We Offer - The Good Stuff:
A mission based company with an amazing company culture.Paid time off & holidays so you can spend time with the people you love.Medical, dental, and vision insurance for you and your loved ones.Health Savings Account (with employer contribution) or Flexible Spending Account options.Paid Parental LeaveEmployer Paid Basic Life and AD&D Insurance.Employer Paid Short- and Long-Term Disability.Optional Short Term Disability Buy-up plan.401(k) Savings Plan, with ROTH option.Legal Plan.Identity Theft Services.Mental health support and resources.Employee Referral program - join our team, bring your friends, and get paid.