Senior Contract Implementation Analyst

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Keeps abreast of current industry trends, governing regulations, reimbursement practices and market players. Keeps VNS Health Plans management informed of trends/changes and makes recommendations based on this information.
• Review and interpret managed care contracts, fee schedules, and related documents. Configure contract terms, payment rates, and rules within the organization's systems.
• Ensure that all contract configurations align with legal, regulatory, and organizational guidelines.
• Continuously update and maintain contract configurations as contracts are revised or amended.
• Collaborates with legal and compliance teams to stay updated on contract changes and regulatory requirements.
• Collaborates with internal departments and external vendors to ensure that annual benefit updates and pricing configurations are mapped, tested, documented, and loaded into production prior to the effective date of the contract. Ensures that fees and coverage rules are implemented annually or more often if dictated by regulating body.
• Analyzes contract terms and data to identify potential issues or discrepancies.
• Monitors contract performance and compliance with reimbursement terms.
• Provides insights and recommendations for improving contract efficiency and effectiveness.
• Works closely with Contracting and Provider Relations teams to resolve contract-related inquiries or issues.
• Assists in resolving disputes or conflicts related to contract interpretation. Collaborate with IT and data management teams to ensure system accuracy and integrity.
• Monitors and validates post-implementation reports to identify and fix configuration issues.
• Participates in interdepartmental work groups in support of process improvement projects, as needed.
• Conducts regular audits to verify the accuracy of contract configurations.
• Identifies and rectify errors or discrepancies in contract data.
• Produces Global Claim projects and claims analysis
• Monitors new and existing process designs to measure operational effectiveness.
• Provides data collection and analytical support to team and monitors projects. Summarizes, creates, and distributes reports as needed.
• Participates in special projects and performs other duties as assigned.

Education:

• Associate's Degree in Business Administration, Healthcare Administration, a related field or the equivalent work experience required

Work Experience:

• Minimum of three years managed health care operations experience required
• Experience with health care information system development required
• Experience managing complex projects across departments required
• Effective communication skills, both written and oral, and proficiency in PC software applications (i.e. Microsoft Office) required
• Knowledge of managed care contracts, reimbursement methodologies, and healthcare industry regulations. required
• Attention to detail and a high degree of accuracy. required
• Knowledge of healthcare terminology and coding (e.g., CPT, ICD-10) is a plus preferred
• Problem-solving and critical thinking abilities required