Senior Provider Contracting Analyst

Company :

Job Description : 

JOB SUMMARY

This position works within the Provider Contracting department and provides analytical and other support for provider contracting, contract administration, and departmental initiatives and projects. The incumbent supports the data and analytical needs of those leading provider negotiations.  They monitor and facilitate the contract loading and ongoing contract administration in Highmark systems.  This role interfaces directly with other departments (Reimbursement, etc.) on the ongoing departmental needs to support contracting and administration activities.

JOB DESCRIPTION

• Monitor activities by tracking the specific terms of each contract and maintaining a mechanism for monitoring and documenting compliance with those terms and perform special studies/audits for all contracts.

• Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences. Analyze data from claim and/or medical record reviews to continually improve the care and service to members and coordinate with the financial recovery areas to retract erroneous or inappropriate payments.

• Support provider contracting activities including negotiations, contract development, contract renewal, and financial reimbursement. 

• Act as the intermediary between the organization and outside entity to ensure all responsibilities as outlined in the contract are fulfilled. Serve as an advocate for managing expectations to achieve positive outcomes. Participate in educational and training sessions for provider billing staff to ensure understanding of and compliance with proper guidelines. 

• Provide control and processing support for final provider settlements and initiating, documenting, processing, and establishing collection protocols for provider settlements.

• Work with sales and customer service to respond to questions/inquiries from customers/members related to appropriateness of services billed by providers.  

• Other duties as assigned.

EDUCATION

Required

• Associate's Degree in Business, Finance, Information Management, Healthcare Administration or Health Related discipline or relevant experience and/or education as determined by the company in lieu of Associate’s degree

Preferred

• Bachelor's Degree in Business, Finance, Information Management, Healthcare Administration or Health Related discipline

EXPERIENCE

Required

• 5 years in the Health Insurance Industry

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Analytical and Logical Reasoning/Thinking

• Contracts Administration

• Problem-Solving

• Customer Service

• Requirements Gathering

• Reporting

• Data Gathering and Analysis

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

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