As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
The Contracts Analyst is responsible for healthcare insurance reimbursement analysis; validating pre-load and post-load of contracts; applying independent judgment in the maintenance of the claims adjudication system; formulating and implementing system improvements, acting as a subject matter expert during contract negotiation processes, making recommendations to the Managed Care negotiators regarding terms of the contract; and collaborating with key stakeholders for the resolution of related issues. The Contracts Analyst responsibilities ultimately affect the business operations to a substantial degree.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Analyzes the Contract Terms and Conditions in a timely manner and makes recommendations for new contract loads, formulates and implements amendments and changes, and rollover contracts as part of the client audit, deviating from established procedures as necessary.
Regularly exercises discretion in analyzing and identifying issues associated with reprice impact reports after communication log issue have been corrected and re-priced. Formulates and implements solutions to identified issues and is empowered to make exceptions when required to move issues to resolution.
Independently audits and verifies post-contract changes.
Collaborates with Client Managed Care and Med Assets Account Rep to ensure contract profiles are pricing accurately, per contract language.
Reviews internal requests for assistance and executes work list/queries for newly opened communication logs. Documents affected accounts as required.
Identifies alternative opportunities in contract interpretation and revenue routing through the analysis of issues and, acting as a subject matter expert, provides alternative recommendations to management and staff. Activation of plan ID s in mainframe system and MedAssets complying with NIC standards. Request approvals from Managed Care for NCCI edits if stated in contract and forward to the appropriate parties for loading.
Communicates with appropriate leadership to ensure discrepancies are resolved prior to close of month end.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential dutysatisfactorily. The requirements listed below are representative of the knowledge, skill and/orability required. Reasonable accommodations may be made to enable individuals withdisabilities to perform the essential functions.
This position requires knowledge of and the ability to perform all functions of the Contract Analyst.
Advanced understanding of hospital billing form requirements (UB-04)
Advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology
Advanced Microsoft Office (Word, Excel)
Advanced knowledge of query writing applications a plus
Advanced managed care/government contract interpretation skills
Strong analytical abilities
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
Minimum 1 year contract interpretation experience required
Bachelor or Associate Degree preferred
3-5 years of relevant hospital business office experience preferred
Must be able to implement a systematic, self-motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Must be able to work in sitting position, use computer and answer telephone
Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
Ability to lift and/or move up to 25 pounds
Specific vision abilities required by this job include close vision.
Ability to travel
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Office Work Environment
Hospital Work Environment
Other duties as assigned
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.