Description
Position: Contract Specialist - Remote
Shift: FT Days 40/hrs per week
We're a Little Different
Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.
At Mercy, we believe in careers that match the unique gifts of unique individuals – careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its “Top 100 Places to Work.”
Overview:
The Contract Specialist develops an understanding of payor contract claims processing and payment terms and conditions with a good working knowledge of key contractual provisions. Assists other Contract Operations team members with claims escalation and settlement process based on identified escalation process parameters.. Ensures the Mercy values are reflected in all aspects of the departments operations. Performs related duties as assigned.
Orients internal and external stakeholders on the benefits and contractual obligations of all plans. Assists stakeholders in understanding the requirements of managed care contracts and/ore utilization management, and related issues to promote positive environment for the health system members across product lines.
Supports Managed Care Operations team in providing the Managed Care Leadership with supportive information for intervention with Payor leadership for resolution of escalated and settlement as necessary.
Interface with Managed Care Operations caregivers, Business Office, Finance, Care Coordination/Utilization Management, other internal departments, and payor contacts to collect pertinent research information in order to address and settle escalated issues in accordance with escalated parameters and contractual guidelines.
Participates in payor provider rep meetings as designated.
Interacts with managed care plan representatives regarding claims issues and other contractual issues.
Works closely with the leadership in health plan ops, contracting, etc.
Updates managed care plans on provider changes, additions and deletions on a monthly basis.
Updates system reports.
Updates internal and external stakeholders on new contracts and contract changes on a monthly basis.
Recognizes issues and uses problem solving to identify inconsistencies in the way we process information and claims, develop alternatives, including new policies and procedures, letters, memos and presentation materials.
Documents all external interactions and reports regularly to the leadership team.
Leads and supports special projects as required.
Maintains managed care contracts in contract repository system and corresponding reports and tracking systems.
Monitor contract operations mailboxs for contract, policy, escalations and/ore cliams issues and disseminate to appropriate teams for resolution.
Qualifications:
Education: High school diploma or equivalent.
Experience: One to three years managed care or health care experience desired with ability to develop and perform.
Other: Skills, Knowledge, and Abilities: Understanding of physician office procedures, medical terminology and/or HMO benefits desired. Familiarity with CPT4, ICD-9 and UB92 coding desired.
Requires a highly self-motivated and independent worker who is able to develop and keep own schedule, is able to prioritize assignments and design programs to meet the needs of individual groups and/or offices.
Strong interpersonal and communication skills with the ability to design tools which will be useful in educating office staffs and physicians in issues related to Managed Care.
Excel or Access knowledge helpful. Working Conditions, Mental and Physical Requirements:
Ability to travel within a defined service area.
Preferred Education: Associates Degree or equivalent.
Preferred Experience: Previous Physician Office or Insurance Company experience in filing/coding claims preferred
We Offer Great Benefits:
Day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds are just a few of the great benefits offered to eligible co-workers, including those working 32 hours or more per pay period!
We're bringing to life a healing ministry through compassionate care.
At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We're expanding to help our communities grow. Join us and be a part of it all.
What Makes You a Good Match for Mercy?
Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We're also collaborative and unafraid to do a little extra to deliver excellent care – that's just part of our commitment. If that sounds like a good fit for you, we encourage you to apply.
Apply on company website
Find Connections via Linkedin
