Contract Compliance Analyst III

Essential Duties

• Develop communication for contracts, amendments, and notifications for the internal Revenue Cycle Team (RCT) customers and collaborate with the Field Managed Care team in negotiations with payers for operational optimization.
• Play a role in the development and maintenance of a contract database and contract management system, working with the credentialing and legal teams.
• Collaborate with finance and analytics to identify, analyze, and determine next steps to address negative revenue pull-through scenarios specific to payers and across payer segments; including Medicare Advantage, Blues, Medicaid, etc.
• Collaborate with RCT Managers and specialists to develop and leverage relationships with billing operations staff and payers when resolving claim adjudication issues, both contractual and non-contractual.
• Support execution of pull-through plans to meet quarterly/annual revenue recovery goals.
• Identify broad revenue opportunities that span a particular customer segment; including utilizing Content Management Systems (CMS) for noncontracted Managed Medicare non-payments and the Employer Coalition initiative.
• Consistently identify opportunities to recover revenue.
• Collaborate with the Managed Care team to identify and prioritize plan(s) utilizing key payers for targeted efforts to impact coverage policy decisions.
• Facilitate conversations with appropriate Exact personnel early in the contracting process to provide an overview of the account to avoid delay in implementation down the road.
• Strong attention to detail and organizational skills.
• Strong analytical skills.
• Ability to drive to results with a high emphasis on quality.
• Ability to present recommendations supported by analytical evaluations.
• Strong ability to prioritize and multi-task.
• Ability to integrate and apply feedback in a professional manner.
• Excellent communication, both written and verbal, across internal and external personnel.
• Ability to collaborate and work effectively as a team member.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the Quality Management System team’s policies and procedures.
• Maintain regular and reliable attendance.
• Ability to act with an inclusion mindset and model these behaviors for the organization.
• Ability to work designated schedule.
• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
• Ability to work on a computer and phone simultaneously.
• Ability to use a telephone through a headset.

Minimum Qualifications

• 3+ years of experience in billing/reimbursement, coverage, claims, and appeals.
• Demonstrated understanding of public and private Managed Care payers and reimbursement process.
• Demonstrated understanding of market-related issues, contract basics, product coverage, and pull through rationale.
• Proficient with Excel and Epic or similar database; demonstrated ability to maintain competency levels.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
• Applicants must be currently authorized to work in country where work will be performed on a full or part-time basis. We are unable to sponsor or take over sponsorship of employment visas at this time.

Preferred Qualifications

• Knowledge of and/or experience with government Managed Care payers.
• Knowledge of billing and coding.