Responsible for analysis of contracts and performing contract negotiations to include monitoring and reviewing existing contracts to ensure payment compliance, communicating and resolving contract issues both internal and external to the organization, and contributing to health system and individual contract negotiation strategies. Develops and builds contract projections models (EPIC) essential to negotiation outcomes for the health system.
Job Responsibilities:-Analyzes contracts and communicates operational impact of contracts to appropriate health system contacts.
-Develop models, analysis, and monitor financial performance of existing and proposed contracts.
-Monitors contract performance and compliance to ensure contracts are performing at expected levels by auditing financials and negotiating with payors for money due if appropriate.
-Reviews and negotiates language in the contracting negotiation processes.
-Develops, produces, and maintains data sets required for contract analysis.
-Develops and maintains departmental processes to manage contracts.
-Resolves contractual disputes with payors by collaborating with various health system entities and all related parties.
-Responsible for the analysis, development, and testing of contract projection models within Epic essential to negotiation outcomes for the system for both physician and hospital contracts/reimbursement.
-Builds programing and performs ongoing analysis, which maintains the integrity of financial expectations of managed care contracts within the Epic system.
-Resolves programming issues related to rate and revenue codes operations through modification to yield maximum revenue potential for both physician and hospital contracts/reimbursement.
-Ensure through Epic testing that the build is developed and performing the collaboration with the Epic team to put into production and to enhance contract modeling within Epic.
-Performs other related duties as assigned to fulfill department responsibilities.
-Decision Making: The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.
-Working Relationships:
-Coordinates activities of others (does not supervise).
-Works with internal customers via telephone or face-to-face interaction.
-Works with external customers via telephone or face to face interaction.
-Works with other healthcare professionals and staff.
-Works frequently with individuals at Director level or above.
Pay Rate: $69k - $99k -
relocation assistance up to $10k to Tulsa, OKRequirements
- Bachelor's degree required (field of study flexible)
- Experience with health plan insurance contracting and reimbursement for providers and facilities.
- Ability to complete Epic certification and maintain certification in assigned application modules(s).
- Ability to work independently and within a team across multiple disciplines.
- Ability to establish and meet work schedules within limited time frames and under tight deadlines.
- Analytical ability to solve both business and technical problems.
- Working knowledge of Microsoft Excel, Word, Power Bl and Access.
- Excellent interpersonal, written and oral communication skills.
- Ability to be detail oriented as required in the analysis and examination of complex information.
Preferred Skills & Experience:
-Experience with Microsoft Access, data warehouse applications, contract negotiations, contract financial modeling, contract language interpretation and EPIC.
