Contract Specialist

Hours per Week: 40.00 —- Shift Hours: 8a to 5p

Additional details about schedule: scheduled Monday-Friday

What you need to know about this position:

• The Contract Specialist oversees the implementation and operations of payor relations and payor contract management for the health system.
• This position is responsible for entering payor contracts into the current contract management system(s) keeping them current and updated at all times while also maintaining a master calendar of all payor contracts.
• The Contract Specialist is responsible for monitoring all payor performance as it relates to contractual variances and recommending areas of opportunity to improve contract and reimbursement optimization to various stakeholders.
• This position is responsible for communicating to key individuals throughout the health system regarding payor’s new and/or updated policy/procedure.
• Individual compensation is determined for this position through years of directly relevant experience. The hourly compensation is only a portion of the total rewards package and a comprehensive benefits program is available for qualifying positions.
• This is a salaried position.
• In a status of at least 16 hours per week, employees are benefit eligible.

What is required for this position:

Upon hire, you must have:

• Bachelor’s Degree or 5-7 years of experience in areas of network management, Contracting, hospital and physician reimbursement, contract management, managed care, payor credentialing, billing, coding, and overall revenue cycle required.
• Progressively responsible work experience in healthcare in a Provider Relations/Customer Service environment or equivalent role.
• Comprehensive knowledge of healthcare managed care principles and understanding of contract language, fee schedules, reimbursement methodologies, Current Procedural Technologies (CPTs), Healthcare Common Procedure Coding Systems (HCPCS), Ambulatory Payment Classifications (APCs), Diagnosis-Related Groups (DRGs), and Outpatient Prospective Payment System (OPPS).

Within 6 months of hire, you must have:

• Epic – Resolute Hospital Billing Expected Reimbursement Contracts Administration Certification or Resolute Hospital Billing Expected Reimbursement Contracts Administration Accredited-Remote.