Contracting Analyst

Description

 

Position Summary: 

The Managed Care Analyst is responsible for contract management for which AdaptHealth is negotiating and entering. Demonstrates expert knowledge about the details and benefits of contracts, as well as potential disadvantages. Assists with contracting projects. 

Essential Functions and Job Responsibilities: 

• Collaborates with Payer Engagement Team to negotiate provider agreements with health plans. 
• Reviews all payer contracts, agreements, and amendments thoroughly and with a high level of detail to ensure all terms and language are aligned with established standards.  
• Communicates with Credentialing Team of needs for new contracts and changes needed to existing contracts. 
• Collaborates with business development to draft, review, and execute facility agreements. 
•  Aids in negotiations for special payment arrangements with health plans and facilities. 
• Focuses on preferred and exclusive arrangements nationwide in partnership with Payer Engagement Team. 
• Ensures current master agreements, announcements, and provider manual updates on SharePoint. 

facilitate new contracts and/ or payer changes are shared with appropriate parties to ensure accurate and timely set up in the system.  

• Distributes updates to applicable departments within AdaptHealth. 
• Assists with negotiating, coordinating, and outreach for single case agreements while verifying payments have been applied correctly to patient accounts. 
• Maintains Master Contracting Log. 
• Monitors contract renewal dates and communicates with Payer Engagement Team to reach out to payers to set up meetings when contracts are up for renewal. 
• Assists Senior Director or Payer Engagement Team with contract negotiations, agreements, and other contracting projects as needed. 
• Coordinates with Managed Care Directors, payors, Sales, to organize meetings and enhance communications. 
• Assists with developing and analyzing patient census, fee schedule and utilization reporting for contract negotiations. 
• Conduct analysis on amendments received to compare and identify the changes and impact.  
• Review requests from sales, operations and directly from payers with Payer Engagement to establish plan of pursuing the contract. 
• Follow up on contracts once signed to obtain dually executed copy and ensure payer set up completion and load and effectively communicate outcomes to appropriate parties.  
• Reaches out to payers for fee schedule and coding updates and to address questions as needed. 
• Contacts payers regarding pricing discrepancies and works to resolve the discrepancies as needed. 
• Coordinates and assists billing and other areas to resolve claim problems with payors as needed. 
• Develops and maintains working knowledge of current HME products and services offered by the company. 
• Maintains patient confidentiality and functions within the guidelines of HIPAA. 
• Completes assigned compliance training and other educational programs as required. 
• Maintains compliant with AdaptHealth’s Compliance Program and applicable company policies, procedures, and patient protocols. 
• Performs other related duties as assigned. 

 

Competency, Skills and Abilities: 

• Independent thinker and decision maker 
• Strong analytical and problem-solving skills with attention to detail 
• Excellent verbal and written communication 
• Excellent customer service skills 
• Proficient computer skills and knowledge of Microsoft Office specifically Excel 
• Ability to prioritize and manage multiple projects. 
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction. 

 

Physical Demands and Work Environment: 

• Work environment will be stressful at times, as overall office activities and work levels fluctuate. 
• Must be able to bend, stoop, stretch, stand, and sit for extended periods of time. 
• Subject to long periods of sitting and exposure to computer screen. 
• Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use. 
• Must be able to lift 30 pounds as needed. 
• Excellent ability to communicate both verbally and in writing. 
• May be exposed to angry or irate customers or patients. 
• Ability to effectively communicate both verbally and written with internal and external customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy. 
• Mental ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagra