Contract Implementation Analyst

Location: Columbus, OH
Contract Implementation Analyst
 
Joining this team means you'll be surrounded by colleagues who are dedicated to meeting their own high standards, to inspiring their teammates and to making a positive impact on under-insured and uninsured individuals. The group is a fast, agile, customer-focused organization with a commitment to implementing the latest technologies.
 
Our client serves more than 55 million managed care members through their portfolio of high-quality commercial and government sponsored healthcare programs. The broad offering of programs that they provide has helped them to build both capacity and capability to successfully navigate a changing healthcare environment, while continuing to offer better health outcomes at lower costs.
 
Position Purpose:
Perform day to day duties and testing of contract implementation, including UAT to ensure that systems accurately reflect a contract’s negotiated terms.
 
Job Description:
  • Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing
  • Review and price contract related pends to ensure claims payment accuracy
  • Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (CRs) (i.e.RHCs/FQHCs/fee schedule updates).
  • Troubleshoot and problem solve contract implementation issues related to basic system configuration
  • Review contracts and assign pay classes and applicable provider information based on contract language. If configuration is needed to accommodate a contract, notify the appropriate parties.
  • Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments
  • Review new and current provider contracts and established state guidelines
  • Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plan, claims and corporate management and information systems staff
 
Qualifications:
Education/Experience:
  • Bachelor’s degree in Business, Finance, related field, or equivalent experience.
  • 1+ years of provider contract implementation, contract analysis or claims analysis experience in managed care, health care or TPA setting.
  • Government programs and Amisys or claims payment configuration experience necessary.
 
 
Preferred Skills/Experience:
  • N/A
 
Licenses/Certifications:
  • N/A
 
Our client offers options that allow you to do more than just plan for retirement. Their programs allow shared success with employees.
  • 401(k) with company match
  • Employee stock purchase plan
  • Training and Learning Opportunities/Tuition Reimbursement/Educational Assistance
  • On-site fitness center or discount at local fitness centers (most locations)
  • Discounts for select local and national products and services, including cell phones, computers and more
  • Other amenities may be available, but vary by location
 
Equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
 
 
 
 
April A. Estes
Senior Recruiter
720-439-2609 Direct
april@proenlist.com 
www.proenlist.com 
www.medenlist.com 

www.linkedin.com/in/aprilaestes
 
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