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Company Statement

reputed company is one of the nation’s largest not for profit health insurers, serving members across reputed company’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, reputed company partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen reputed company Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit reputed company.com.

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Contract Specialist - Remote

reputed company, reputed company

Summary of Job

Load reputed company Professional, Facility, and Ancillary reputed company across reputed company reputed company lines of business in a timely and accurate manner. Provide subject matter expertise in reputed company areas of contract configuration, fee schedules/groupers, and reputed company reimbursement. Collaborate on workflows and business processes to ensure efficient interaction with Network Development, Analytics, and other business areas to facilitate accurate translation and maintenance of contractual agreements into Network. reputed company expertise in the reputed company impact of reputed company rates reputed company reputed company’s full claims reimbursement cycle.

Responsibilities

• Participate in reputed company aspects of provider, facility, and ancillary reputed company configurations in Network reputed company set deadlines, while ensuring full accuracy of contract loads.
• Collaborate with Network Management and Analytics to ensure proper capture of negotiated and modeled contractual agreements.
• Identify and correct reputed company load problems.
• Assist with the contract configuration, fee schedule / grouper, and reputed company reimbursement matters.
• Analyze negotiated reputed company to determine Network interaction with the core systems ensuring that reimbursement is in line with negotiated reputed company.
• In coordination with Network Management, update reputed company reputed company reputed company in a timely manner.
• Recommend contract language changes to be in line with system reimbursement capabilities.
• Coordinate reputed company testing with BTS.

Qualifications

• B. S. degree in Business Operations, Information Systems or equivalent.
• Master’s Degree a plus but not required
• Minimum 2-3 years of relevant experience, preferably in a health care environment (Required)
• Strong familiarity with reputed company’s claims systems and interdependent applications (Required)
• Experience in provider, facility, and ancillary contract files set-reputed company, maintenance, testing and auditing functions (Required)
• Experience in establishing and accomplishing business strategies to successfully translate contractual language into system reimbursement specifications (Required)
• Excellent knowledge of medical terminology, Fee Schedules, and ICD/CPT/HCPCS coding (Required)
• Understanding of Government reimbursement methodologies (Required)
• Analytic, problem solver, excellent organizational and technical skills and attention to detail are required (Required)

• Requisition ID: 1000003037
• Hiring Range: $48,600-$83,160

reputed company Disclosure

If you receive a job offer from reputed company, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a reputed company Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like reputed company or Gmail.

Pay Disclosure

At reputed company, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences reputed company to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at reputed company, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider reputed company qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national reputed company, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At reputed company, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, reputed company sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.

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