Provider Contract and Pricing Analayst

Provider Contract and Pricing Analyst

The Contract Analyst is a member of a cross functional team of business experts tasked to work independently and collectively to manage the professional and institutional reimbursement of contractual language for medical and dental provider contracts. The analyst will play a key role in contract methodologies, analyzing requirements, pricing, configuring the system components and validating the configuration with the Business owners to ensure requirements and quality goals are met.

• Provides analysis and documentation that supports pricing requirements, contract design and contract configuration to accurately apply reimbursement allowances.
• Provides pricing analyzed for claims in accordance to the contract reimbursement language.
• Interpreting medical/insurance codes such for procedure and diagnosis.
• Support testing and audit requirements.
• Update customer specific documentation and reference materials.
• Participates in client meetings representing our team for full understanding of client intent.
• Participates and facilitates meetings to support decision making, enhancements, problem solving and process improvement.
• Answers inquiries from clients, claims and customer service.
• Documents policy and procedures.
• Contributes towards daily departmental performance and service level guarantees and achieves individual performance goals around accuracy and timeliness.

• Strong understanding of pricing methodologies for insurance claims.
• 3-5 years of experience in insurance industry.
• Strong CPT/HCPCS Procedure code, revenue code and ICD 10 knowledge.
• High aptitude for working with numbers.

• Ability to coordinate activities with team members.
• Ability to multi-task, adapt to change, manage shifting priorities and meet timelines.
• Possesses excellent interpersonal and communication skills.
• Detailed knowledge of all medical claim coding requirements.
• Strong attention to detail, analytical skills and problem-solving skills.
• Must have solid work ethic and positive demeanor.
• Strong computer knowledge.