Senior Provider Contracting Analyst

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This position works within the Provider Contracting department and provides analytical and other support for provider contracting, contract administration, and departmental initiatives and projects. The incumbent supports the data and analytical needs of those leading provider negotiations. They monitor and facilitate the contract loading and ongoing contract administration in Highmark systems. This role interfaces directly with other departments (Reimbursement, etc.) on the ongoing departmental needs to support contracting and administration activities.

JOB DESCRIPTION

Monitor activities by tracking the specific terms of each contract and maintaining a mechanism for monitoring and documenting compliance with those terms and perform special studies/audits for all contracts. Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences. Analyze data from claim and/or medical record reviews to continually improve the care and service to members and coordinate with the financial recovery areas to retract erroneous or inappropriate payments. Support provider contracting activities including negotiations, contract development, contract renewal, and financial reimbursement. Act as the intermediary between the organization and outside entity to ensure all responsibilities as outlined in the contract are fulfilled. Serve as an advocate for managing expectations to achieve positive outcomes. Participate in educational and training sessions for provider billing staff to ensure understanding of and compliance with proper guidelines. Provide control and processing support for final provider settlements and initiating, documenting, processing, and establishing collection protocols for provider settlements. Work with sales and customer service to respond to questions/inquiries from customers/members related to appropriateness of services billed by providers. Other duties as assigned.

EDUCATION

Required Associate's Degree in Business, Finance, Information Management, Healthcare Administration or Health Related discipline or relevant experience and/or education as determined by the company in lieu of Associate's degree Preferred Bachelor's Degree in Business, Finance, Information Management, Healthcare Administration or Health Related discipline

EXPERIENCE

Required 5 years in the Health Insurance Industry Preferred None LICENSES or

CERTIFICATIONS

Required None Preferred None SKILLS Analytical and Logical Reasoning/Thinking Contracts Administration Problem-Solving Customer Service Requirements Gathering Reporting Data Gathering and Analysis Language (Other than English):

None Travel Requirement:

0% - 25%

PHYSICAL, MENTAL

DEMANDS and

WORKING CONDITIONS

Position Type Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required

Yes Lifting:

up to 10 pounds

Constantly Lifting:

10 to 25 pounds

Occasionally Lifting:

25 to 50 pounds

Rarely Disclaimer:

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement:

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$68,400.00

Pay Range Maximum:

$105,900.00 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America's largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health's 35,000 employees serve millions of customers nationwide through the nonprofit organization's affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health's businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.