Managed Care Contract Analyst

Remote Full-time
Job Purpose: Contract Analyst will be responsible for analytic support related to ION network and providers. Team member will work closely with the Managed Care department team in generating and reviewing system data, while making strategic recommendations. The role includes loading and maintaining reimbursement rates in ION contract management system. Additional responsibilities include collaborating with other internal teams with reimbursement related concerns and acting as a liaison to managed care plans. Essential Functions: • Support Managed Care team with matters relating to external providers, plan sponsors regulatory agencies, managed care payers, and the community. • Load contracted rates into contract management system. • Analyze relevant data to provide in reports, which includes determining the impact of adjustments to managed care reimbursement terms and/or contract compliance, along with rate modeling necessary for contract negotiations. • Collaborate with reimbursement analytic team to determine accuracy of insurance payments. • Create presentation materials for internal and external meetings. • Act as business liaison to assigned business unit meetings and committees, which includes presenting and discussing new subject matter. • Identify and recommend improvements in processes for greater operational efficiency. • Maintain various department spreadsheets and databases. • Review managed care payer contracts with a focus on interpreting and implementing reimbursement terms in a multi-functional approach to Managed Care strategies. • Assume other projects and assigned job duties related to managed care, as needed. • Auditing contracts to ensure proper payment in the Experian tool. • Working with payers to resolve contract loading errors identified from audits. • Work in underpayment tool to appeal claims and recoup underpaid claims not paid according to the agreement. Qualifications: • Education: Bachelor's Degree or equivalent experience • Skills: Health care reimbursement experience in a health system, consulting firm, or with a managed care payer preferred. Knowledge of basic Microsoft Office tools required. Ability to work individually and in a team setting. Strong communication skills are necessary. • Years of Experience: 1-2 in Managed Care + contract negotiating experience with managed care payers. Preferred Qualifications: • Skills: Advanced knowledge of Microsoft Office tools • Years of Experience: 3+ in Managed Care Physical Demands and work environment The physical demands and work environment characteristics 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. Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying ten pounds maximum, seeing, speaking and hearing. Work environment: Required job duties are normally performed in a climate-controlled office environment. Apply tot his job
Apply Now

Similar Opportunities

Experienced Registered Behavior Technician for In-Home ABA Therapy - Atlanta, GA

Remote Full-time

Immediate Hiring: Experienced Registered Behavioral Technician (RBT) for Clinic-Based ABA Therapy Services

Remote Full-time

Experienced Registered Behavioral Technician (RBT) - ABA Therapy for Children with Autism Spectrum Disorder

Remote Full-time

Experienced Registered Nurse - Telehealth: Providing Remote Care Coordination and Patient Support

Remote Full-time

Experienced Substitute Teacher for Riverside County Schools - Join Scoot Education's Innovative Team

Remote Full-time

Experienced Substitute Teacher for San Bernardino County - Flexible Schedules & Competitive Pay

Remote Full-time

Experienced School Year Instructional Coach for High-Dosage Tutoring Programs in Edgewater Park, NJ

Remote Full-time

Experienced School Year Tutor for K-8 Students in Math and Literacy - Mickleton, NJ

Remote Full-time

Experienced Secondary Social Studies Teacher for Kansas - Flexible Hybrid Remote Arrangement

Remote Full-time

USPS Office Helper

Remote Full-time

Experienced Client Relationship Analyst – Walgreens Data Entry & Customer Support Specialist ($32/Hour)

Remote Full-time

Integrated Nurse Case Manager/RN/Maternity/OBGYN

Remote Full-time

Healthcare Regulatory Attorney (Remote Contract Engagement)

Remote Full-time

**Experienced Live Chat Customer Support Specialist – Remote Opportunity with blithequark**

Remote Full-time

User Acquisition Manager (PawChamp)

Remote Full-time

Senior Customer Service Representative - Expert Client Relationship Builder & Liaison for Financial Institutions and Corporations at blithequark

Remote Full-time

Remote Software Developer jobs – Full‑Time Senior Backend & Front‑End Engineer (React / Node.js) – Pelham, Alabama – $110k‑$150k – Remote‑First, Cloud‑Native, 100% Distributed Team

Remote Full-time

Analyst, Finance Operations Technology Enablement

Remote Full-time

Senior Java Developer – GCP & Big Data

Remote Full-time

Manager, Quality Assurance, Virtual Sales

Remote Full-time
← Back to Home