Network Contract Analyst

Role Description

The Network Contract Analyst performs contract administration activities encompassing among other tasks the preparation of contract settlements to ensure that claims are ultimately paid in accordance with the provisions of the contracts and that the Plan payment levels are reasonable and accurate based on the nature and scope of services rendered.

• Perform research, analytic and reporting work in support of the Provider Contracting and Value Based Programs ACA agreements.
• Work with team manager and other analysts to develop and administer contracts between Capital BlueCross and various providers of health care services.

Responsibilities

• Assist in developing an annual plan for the team considering available resources and anticipated workload.
• Responsible for the analytical functions necessary to effectively and efficiently administer provider contracts.
• Prepare provider contract settlements ensuring accuracy and reflection of payment provisions.
• Manage the Cost Rate Adjustment (CRA) process, including data accumulation and reconciliation.
• Present suggestions for developing and revising workflows related to provider contract administration activities.
• Respond to questions and concerns raised by providers regarding their contracts with the Plan.
• Assist with the resolution of reimbursement issues encountered during contract settlements.
• Participate in drafting contracts for new providers and amending contracts for existing providers.
• Assist with data analysis to support Provider Contracting during negotiations.
• Represent the team in Plan projects affecting various departments.
• Research and analyze provider payment modifications at the State and Federal level.
• Develop proactive analytical studies to assess changes in provider billing patterns.
• Respond to and provide documentation for claim payment audits and surveys.
• Coordinate the configuration and implementation of professional provider pricing schedules.
• Assist with the implementation process for maintenance of pricing schedules.

Qualifications

• Fairness, honesty, and respect for all team members.
• Strong oral and written communication skills.
• Ability to perform in a team environment.
• Ability to work independently with minimal supervision.
• Ability to recognize potential problem areas affecting reimbursement.
• Ability to perform analytic functions necessary for administering provider contracts.
• Ability to perform data analysis related to provider reimbursement.
• Ability to review data and summarize it clearly.
• Demonstrated ability to prepare detailed reports.
• Ability to communicate with provider financial personnel professionally.
• Flexibility in work habits to respond to changes in the healthcare environment.
• Demonstrated ability to drive results while managing multiple projects.

Knowledge

• Knowledge of Capital BlueCross provider contract provisions.
• Experience with tools such as Microsoft Office Suite, Crystal Reports, Tableau, and SAS.
• Familiarity with operational aspects of different provider types.
• Knowledge of general accounting practices and auditing procedures.
• Familiarity with Medicare and Medicaid reimbursement methodologies.

Experience

• 2-3 years’ experience in a health care environment with proven analytical expertise is desired.

Education and Certifications

• Prefer a Bachelor's Degree in accounting, business administration, health planning and administration, or an Associate’s degree with relevant work experience.

Work Environment

• Typical office conditions.

Physical Demands

• Sedentary work involving significant periods of sitting, talking, hearing, keying, and performing repetitive motions.
• Requires visual acuity to perform close inspection of documents and PC monitor.

Benefits

• Comprehensive benefits package including Medical, Dental & Vision coverage.
• Retirement Plan.
• Generous time off including Paid Time Off, Holidays, and Volunteer time off.
• Incentive Plan.
• Tuition Reimbursement.