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Oversees demographic information, in-load, and auditing of provider contracts.
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Conducts data analysis and project management support. Supports network expansion efforts.
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Understands risk contracts.
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Works closely with the Network Contracting staff regarding contracting and contract management inquiries.
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Draft, negotiate, process, and implement contracts, amendments.
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Review and monitor contractor compliance with program requirements and state and federal regulations.
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Responsible for maintaining up-to-date knowledge regarding scope of services provided by AmeriHealth Caritas.
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Maintains complete, accurate, and up-to-date contract records, files, log and reports.
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Work with department and service leaders in resolving contract related issues and contract development and performance.
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Analyst develops a modeling process for negotiated rate changes with Managed Care payors for hospital services.
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Develops payment related tools such as payer rate grids and fee schedule comparison databases.
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Works with Contract Management team to identify and correct build issues related to payment variances.
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essential role in ensuring the accuracy and compliance of provider contracts and transactions.
Knowledge, Skills, Abilities and Other Characteristics
PREFERRED QUALIFICATIONS
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Knowledge of healthcare service pricing and reimbursement methodologies.
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Contract administration experience including vendor and contractor management.
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Cross-functional project management experience including plan drafting, project timelines, and deliverables reporting for provider contracts.
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3 - 5 years provider contract negotiation experience in the health care field including, but not limited to, provider's office, managed care organization, or other health care field.
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Knowledge regarding current and evolving provider payment methodologies.
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Strong understanding of managed care, delivery systems, and reimbursement.
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Strong reading comprehension with attention to detail.
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Excellent verbal and written communication skills.
About the hiring group…As part of the AmeriHealth Caritas DC Clinical Support team, you will be responsible for engaging the member and providers to assess, plan and establish individual member goals.
Benefits We Offer: We provide an industry-competitive benefits package to include:
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Medical/Dental/Vision Insurance w/Health Savings Accounts (HSA)
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Flexible Spending Account(s) (FSA)
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401(k) Retirement Plan
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Paid Holidays, Vacation, & Sick Leave
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Professional Training & Development Reimbursement
Enlightened is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.