Prisma Health
Managed Care Contract Analyst, Corporate, FT, Day
Prisma Health, Boyce Lawn, South Carolina, United States
Inspire health. Serve with compassion. Be the difference.
Job Summary Coordinate system-wide hospital and physician services contracting, including but not limited to, strategy formulation, contract terms and contract performance. Coordinate the implementation, presentation and servicing of all contracts for the entire system. Provides system wide managed care education and communication.
Accountabilities
Coordinate the processing of all payer contracts and amendments. Coordinate all the steps required in the development, review and processing of new contracts, contract renewals and contract amendments with payers. Coordinate all required steps for the execution of contracts and amendments and ensure completion or execution of finalized contracts and amendments within specified time frames or deadlines. Perform detailed review of the business terms in contracts and amendments received from payers, identify unacceptable terms and recommend revised terms that meet the needs of Prisma Health. Negotiate single case agreements when necessary. 40%
Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers. 10%
Develops and maintain contracting decision making and tracking tools. 10%
Develops model contracts or contract language for use in proposing contract or amendments to payers. Establish reporting techniques that will identify areas of concern and prepare recommendations to address any issues. 15%
Provide problem solving support to Prisma Health affiliates and departments. Work closely with payers to ensure that Prisma Health receives all provider manual changes, provider bulletins, benefit plan changes and other payer documents. This position distributes this information throughout Prisma Health in a timely fashion. Conduct pro-active communication, contract compliance, and educational sessions. Develop and maintain effective relationships with payers and internal customers 25%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
Bachelor's Degree.
5 years-Managed-care experience, preferably in a contracting or provider relations role.
Required Certifications/Registrations/Licenses
N/A
In Lieu Of The Minimum Requirements Listed Above
In lieu of manage care experience, fie years experience in healthcare administration, health insurance, or provider contracting.
Other Required Sills and Experience
Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques- Required
Work Shift Day (United States of America)
Location Independence Pointe
Facility 7001 Corporate
Department 70019069 Managed Care Contracting
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
#J-18808-Ljbffr
Job Summary Coordinate system-wide hospital and physician services contracting, including but not limited to, strategy formulation, contract terms and contract performance. Coordinate the implementation, presentation and servicing of all contracts for the entire system. Provides system wide managed care education and communication.
Accountabilities
Coordinate the processing of all payer contracts and amendments. Coordinate all the steps required in the development, review and processing of new contracts, contract renewals and contract amendments with payers. Coordinate all required steps for the execution of contracts and amendments and ensure completion or execution of finalized contracts and amendments within specified time frames or deadlines. Perform detailed review of the business terms in contracts and amendments received from payers, identify unacceptable terms and recommend revised terms that meet the needs of Prisma Health. Negotiate single case agreements when necessary. 40%
Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers. 10%
Develops and maintain contracting decision making and tracking tools. 10%
Develops model contracts or contract language for use in proposing contract or amendments to payers. Establish reporting techniques that will identify areas of concern and prepare recommendations to address any issues. 15%
Provide problem solving support to Prisma Health affiliates and departments. Work closely with payers to ensure that Prisma Health receives all provider manual changes, provider bulletins, benefit plan changes and other payer documents. This position distributes this information throughout Prisma Health in a timely fashion. Conduct pro-active communication, contract compliance, and educational sessions. Develop and maintain effective relationships with payers and internal customers 25%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
Bachelor's Degree.
5 years-Managed-care experience, preferably in a contracting or provider relations role.
Required Certifications/Registrations/Licenses
N/A
In Lieu Of The Minimum Requirements Listed Above
In lieu of manage care experience, fie years experience in healthcare administration, health insurance, or provider contracting.
Other Required Sills and Experience
Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques- Required
Work Shift Day (United States of America)
Location Independence Pointe
Facility 7001 Corporate
Department 70019069 Managed Care Contracting
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
#J-18808-Ljbffr