Provider Contract Analyst

Description

Overview: America’s PPO is currently seeking a Provider Contract Analyst responsible for negotiating, managing, and maintaining contracts for our Preferred Provider Network. This role is integral in collaboration with all HealthEZ departments in streamlining and developing processes, ensuring client expectations are exceeded while increasing revenue and decreasing expenses. This individual will establish and foster strong positive relationships with providers and internal staff. In addition to negotiations, this individual will ensure timely and accurate implementation of provider contracts, amendments, and/or terminations.

The Day-to-Day:

• Reach out to providers offices to contract with the network, also respond to inquiries from provider offices looking to contract with the network.
• Actively negotiate payment structures and reimbursement rates with timely response and follow up, partnering with Contract Manager for support and guidance.
• Ensure accurate data entry, system implementation, and audit of the below, providing timely response to status requests for internal and external stakeholders.
  • network applications
  • provider contracts/amendments
  • single case agreements,
  • fee schedule updates
  • demographic changes (Tax ID, address, name, etc)
• Develop and maintain service relationships with participants of the network.
• Respond to electronic and direct inquiries from providers and internal customers about contracts, pricing, claims, fee schedules, network application requests and statuses, rate changes, billing and payment.
• Investigate and resolve provider billing and claims concerns.
• Prepare reports, compiles and analyzes data and maintains pertinent historical information.
• Responsible for a high level of service excellence, data entry and email communication
• Support continuous improvement of the contract lifecycle and implementation.

Qualifications

Requirements:

• Bachelor’s degree or an Associate Arts degree in a related field of healthcare, business management or 3 years of related work experience; healthcare experience preferred.
• Ability to effectively communicate in both written and verbal forms with strong attention to detail.
• Ability to manage multiple, time critical deadlines.
• Ability to work collaboratively across many teams within an organization.
• Excellent interpersonal and customer service skills.
• Proficient in multiple software applications including Microsoft Office.