Job Description

Handles administration of contracts, including comprehensive review and processing. In addition, individual will be accountable for payer and revenue analytics, payer contract compliance, and systems monitoring.

ESSENTIAL JOB FUNCTIONS:

• Track and monitor contracts throughout their lifecycle from inception to execution and post-implementation.
• Establishes and maintains positive relationships with health care plans to facilitate the sharing of information, analysis, and other information important to the provider/payer relationship.
• Responsible for creating and maintaining contract databases based on contract clause review and any new or updated payer or contracted group information.
• Timely & accurately obtain and verify contracted payers’ process for provider enrollment, APP billing requirements, and any special claims set up requirements and notify appropriate departments.
• Research commercial & government payer websites or communicate with payers to obtain current & updated fee schedules including APP and modifier reductions
• Accurately calculate fee schedules based on contractual percentages and terms for all payers who do not provide a specific fee schedule.
• Precisely format fee schedules per approved standards and update in all appropriate areas of current contract database
• Convey to other departments changes in fee schedules, APP, and modifier reductions
• Generates and analyzes changes in carrier standard rates to determine increase/decrease in revenue.
• Report revenue changes to department leadership.
• Audit existing payer contracts to ensure proper payment and reduction policies are implemented in both our system and the payer’s system per contractual agreement.
• Analyze claims data by utilizing Excel and other tools to ensure proper payment per contractual agreement.
• Identify emerging reimbursement issues and communicate to department leadership
• Collaborate with payer to resolve contractual issues, including but not limited to, claims payment, fee schedules, and assists with internal resolution.
• Facilitate notification to contracted payers of new service locations with payer specific required information
• Create, maintain, and update multiple matrixes of all contracted and national payers for management and tracking of new group/location notification and follow up
• Monitor contracted payer claims for new service location to ensure claims are reimbursing per the contractual agreement.
• Prepare provider rosters with payer’s required information
• Research government and out of network billing and enrollment processes as necessary.
• Investigate and resolve claim denials for in network and out of network provider enrollment issues.
• Ensure all communication with payer is saved to contract database.
• Accountable for meeting or exceeding departmental performance standards and time sensitive deadlines as defined.
• Works independently within scope of responsibility and authority. Understands and follows rigorous state and health plan requirements, determines tasks priorities, and escalates issues requiring management approval or special processing requirements. Must be able to work with high volume projects while multi-tasking.
• Adheres to departmental policies and procedures.
• Creates and maintains Integration tasks for tracking of special projects.
• Perform other duties and projects as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of and skill in using personal computers in a Windows environment.
• Basic expertise of Microsoft Office products; with advanced expertise in Excel.
• Knowledge of healthcare industry including billing and claims, medical coding, payer/provider relations, contracting processes, fee schedules, and reimbursement methodologies.
• Ability to access and research payer and regulatory statutes related to healthcare.
• Ability to access and research claim issues on payer websites.
• Skill in operating various office equipment such as personal computer, calculator, facsimile, copy machines, document shredder, and scanner.
• Ability to work well under pressure and meet strict deadlines.
• Strong analytical and problem-solving skills.
• Ability to organize and prioritize job tasks and requirements.
• Ability to use solution-focused problem solving and to think through problems creatively.
• Ability to communicate with employees, management, and payer representatives in a courteous and professional manner.
• Must have good working knowledge of correct English and grammar usage in verbal and written communications.
• Ability to effectively perform in a multi-task work environment and adapt to change in a positive manner.
• Ability to work overtime as needed.
• Ability to comply with Federal and State laws and regulations pertaining to patient care, patients’ rights, safety, billing, and collections.
• Adhere to all departmental policies and procedures.

EDUCATION AND EXPERIENCE:

• High school diploma required or equivalent; college coursework or equivalent relevant medical billing, payment processing, and analysis experience.
• Experience in Appeals, Follow Up, or Patient Services required.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Referral program
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Application Question(s):

• How many years of Medical Billing experience do you have?
• Describe what a Pivot table in Excel is

Work Location: Remote

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