• Contracting Specialist

    Location US-NY-Buffalo
    Job Type
    Full-Time
    Zip
    14208
    # of Openings Remaining
    1
    Travel
    0%
  • Position Summary

    As one of Upstate New York’s fastest growing urgent care providers, we’re looking for professionals that demonstrate a continual commitment to provide the highest quality, patient-centered care in a warm and friendly setting.  As reflection or our continued growth we have an opportunity to join our team as a Contracting Specialist. This position is located in Ellicottville, NY. 

     

    Responsibilities

    • Be the point of contact in payer contract-related communications
    • Be responsible for maintaining payer fee schedules
    • Be responsible for maintaining payer comparison grid for analysis
    • Manage & configure contract reimbursement methodologies within specific time-frames into practice management system(s)
    • Partners with other departments to ensure appropriate data is collected and maintained
    • Interprets and configures contract terms and claims coding in a risk based environment
    • Understands health insurance benefit administration in a risk based environment
    • Acts as a resource to other internal departments on contract issues
    • Expected to meet or exceed departmental time-frames and quality metrics on a consistent basis
    • Takes ownership of the work process, seeks ways to improve job and process efficiency and makes appropriate suggestions and solutions to management
    • Ability to respond to inquiries from internal / external depts. and providers in a timely manner
    • Updates provider file in practice management billing system upon receipt of participation data.
    • Monitors provider files making sure all pertinent data is current and active such as DEA license, State Medical License, insurance contracts and hospital privileges.
    • Manages all provider credentialing and re-credentialing activities of the practice network in a manner that mitigates the risk of financial losses to the network. Coordinates efforts with Operational leaders through the on boarding process.  
    • Obtains appropriate documents from various resources to complete payer applications. Completes accurately all applications for payer credentialing and re-credentialing in a timely manner.
    • Maintains monthly update of physician participation list.
    • Supports the development of payer contract negotiation strategies and support the analytical needs of the organization.
    • Facilitates the loading and input of all new and revised payer contract terms within Revenue Cycle Management Practice Management System and ensuring accurate interpretation and operational compliance with payer rules.    
    • Develops contract utilization and monitoring criteria to provide the Five Star leadership & administrators with information pertaining to contracts and policies and procedures for operationally administering contract rules.
    • Assists with denial trends associated with payer related issues and ensures that underpayments are minimal and issues are escalated as necessary through the payer for resolution.  
    • Develops and maintains excellent and productive working relationships with physicians, administrative leaders, and provider relations management at pertinent health plans, insurance companies and state and local government contacts pertaining to payer and plan issues.

    Minimum Education and Experience

    • A high school diploma is Required, college Degree is preferred
    • A minimum of 2 year(s) of customer service experience required, preferably in a revenue cycle management, healthcare business development or practice operations experience setting
    • A minimum of 2 years of demonstrable use of MS Office products (Word, Outlook, Excel, PowerPoint) is required

     

    All qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status.

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