Managed Care Contract Specialist

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

$21.33 - $27.73

Scheduled Weekly Hours:

40

Position Overview

Under the direction of the VP of Payer Relations, responsible for reviewing all managed care contracts and the yearly updates. Works with departmental leadership to load all contracted rates in a timely manner. Conducts maintenance and monitoring of the contracts by running ad-hoc reports to ensure compliance and accuracy of pricing according to the various contracts. Works with Management team in the Revenue Cycle department to verify all pricing discrepancies.

MINIMUM REQUIREMENTS
Education:    High School degree or equivalent. Bachelor’s degree preferred.
Experience:    Five years' experience in hospital-based billing. ICD-10 knowledge preferred.
Other Credentials:    
Knowledge and Skills:    Proficient knowledge of healthcare billing. Outstanding organization skills. Excellent verbal and written communication skills.
Special Training:    Proficient in Microsoft Office. Ability to quickly learn the billing system to become proficient.
Mental, Behavioral and Emotional Abilities:    Ability to manage multiple tasks simultaneously and ability to change priorities when necessary to meet deadlines. Demonstrates good judgment as well as attention to detail.
Usual Work Day:    8 Hours  
Reporting Relationships
Does this position formally supervise employees? No

If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

ESSENTIAL FUNCTIONS
Facilitates and coordinates process standardization with vendor to promote accurate contractual allowances in the contract management tool.
Reviews claim calculations in contract management tool, identifies discrepancies between the tool and contractual terms and works with the vendor or the payer to resolve discrepancies.
Performs root cause analysis behind payment calculation variances and identifies improvement opportunities for contract management software vendor as appropriate.
Provides ongoing evaluation and assessment of payer contracts, correlation tables, fee schedules, etc. through claims data to ensure the contract management tool remains current and accurate.
Coordinates with management and other revenue cycle leaders on contract valuation issues resulting in payment discrepancies. Assures payment discrepancies are quantified timely and accurately.
Partners with Hospital and Professional Billing Department to engage with different payers in providing feedback regarding trends and issues. Assures compliance of payers with regulatory guidelines and contract provisions.
When discrepancies are found, identifies if it's due to the contract load or due to the payer. When due to the contract load, it goes back to the vendor to have any incorrect loads updated. When due to payer issues, adds all issues to the Payer spreadsheet and works with our Payer Representative to resolve and completed in conjunction with revenue cycle management team.
Obtains a thorough understanding of payer reimbursement practices and procedures.
Contributes to topics included on payer agendas and spreadsheets to support Billing and Contract Management leadership in efficient communication for consistent resolution of payer contracting issues.
Remains current with changes in payer medical policies that impacts claim pricing methodologies and adjusts contract management software and/or communicates impact to management.
Performs other duties as assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include: Pinching/fine motor activities , Keyboard use/repetitive motion , Talk or Hear

Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation

Continuous physical demands include: Sitting

Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing
Anticipated Occupational Exposure Risks Include the following: N/A
 

IND123.

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.