Provider Reimbursement Contract Specialist II - Provider Contract Administration
This position is responsible for Health Care Provider Contracts; standing up the provider contracts / rates / pricing models into the system. Reviewing system capacity for variety of non-standard contracts. Implementing and auditing contract completion, handling/responding to contract inquiries by conducting research, coordination across various departments fro resolution / solution, conducting contract analysis and modeling, conducting quality control and analysis of quality reporting, preparing quality improvement recommendations, and develop documentation and training materials.
Four years' experience working in a managed care/ health care environment.
1 year experience in health care contract pricing implementation / contract administration, audit contracts in system for completeness.
Health care management database experience. Experience in one or more of the following systems; Access, Blue Chip, Vistar, Terminal Emulator, Premier Pricing, and/or Premier Provider.
Knowledge of managed care contracts.
Knowledge of CPT, HCPCS, ICD9, Revenue code and/or DRG coding practices.
Project management experience.
Technical documentation skills.
Flexibility to meet deadlines in an environment of constantly changing priorities and workloads.
Analytical skills including modeling.
Verbal and written communications skills including interpersonal skills to work across the organization to resolve problems, responding to inquiries, compose procedure manuals and training materials, and to discuss business and technical aspects with all levels of management.
Knowledge with both mainframe and windows based applications.
PC skills including Microsoft Office with proficiency in Excel.
PREFERRED JOB REQUIREMENTS:
• functional knowledge of how contracts work.
• functional knowledge of binding terms and provisions in a contract.
• functional knowledge of payment methodology.
•actual experience with the science of coding
PREMIER Inquiry capable.
•Vistar inquiry capable
•Familiarity with provider network management teams / operations.
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Network Management / Provider Relations Job Type Full-Time Regular Location TX - Richardson
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