Provider Contract and Business Analyst

Job Type: 
Insurance
Industry: 
Healthcare - Health Services
Manages Others: 
No
Education: 
High School
Experience: 
5
Travel: 
Minimal

Other responsibilities you can look forward to;

·  Research and analyze provider fees using system generated data as well as outside data to determine discounted fee schedules designed within the organization’s mission statement and designated goals.            

·  Negotiation and re-negotiation of discounted fee schedules with health care providers in keeping with corporate goals and requirements.

·  Implement new contracts within the designated entity of the organization through written procedures and training of appropriate personnel in each area of the organization i.e. customer service, claims, sales, underwriting, utilization review, field office personnel, account management & service representatives. 

·  Coordinate and implement the installation of new provider contracts with each provider office and their staff, including written procedures for billing, eligibility verification and other contractual requirements.            

·  Handle customer service requests for provider contracting issues.

·   Prepare and provide monthly management reports on participating and non-participating cost savings and performance to the Manger of Cost Containment.

Job Requirements: 

·  Bachelor’s degree in Business, Healthcare or similar field preferred and/or five years’ experience in provider contract components, fee schedule determination, credentialing, claims processing and pricing.

·  Exceptional in-depth healthcare/insurance knowledge for medical and dental provider relations and operations. Knowledge of provider fee schedule developments in DRG, CPT, CDT, RBRVS and HCPCS.

·  Detail oriented with strong analytical and mathematical skills and effective project management skills and the ability to manage multiple projects at one time.

·   Ability to travel on a moderate basis (approximately 30%).

Contact Information
Send Resume To: 
pamelaflores