Project Accountant
Encore Renewable Energy
Provider Contract Analyst
Highmark Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Pennsylvania • 🇺🇸 United States
Visit company websiteSalary
💰 $50,200 - $91,200 per year
Job Level
Mid-LevelSenior
About the role
- Monitor activities by tracking the specific terms of each contract and maintaining some mechanism for monitoring and documenting compliance with those terms.
- Perform special studies/audits, coordinating office site visits and medical records reviews, ensuring resolution of member/provider complaints in timely manner.
- Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences.
- Conduct, collect and analyze data from claim and/or medical record reviews to continually improve the care and service to members and coordinate with the financial recovery areas to retract erroneous or inappropriate payments.
- Manage contracts including negotiations, contract development, contract renewal, and financial reimbursement.
- Act as the intermediary between the organization and outside entity to ensure all responsibilities as outlined in the contract are fulfilled.
- Serve as an advocate for managing expectations to achieve positive outcomes.
- Participate in educational and training sessions for provider billing staff to ensure understanding of and compliance with proper guidelines.
- Provide control and processing support for final provider settlements and initiating, documenting, processing, and establishing collection protocols for provider settlements.
- Work with sales and customer service to respond to questions/inquiries from customers/members related to appropriateness of services billed by providers.
- Consult with Medical Director on questions/issues related to medical necessity and appropriateness of services.
- Other duties as assigned or requested.
Requirements
- Associates Degree in Business, Finance, Information Management, Healthcare Administration or Health related discipline (Required)
- Bachelor's Degree in Business, Finance, Information Management, Healthcare Administration or Health related discipline (Preferred)
- None required for experience (Required)
- 5 years in Healthcare administration/delivery/finance or a related field (Preferred)
- Certified Public Accountant (CPA) (Preferred)
- working knowledge of third party payment concepts
- solid understanding of health care finance and regional market environment
- Extensive experience with Microsoft Word, Excel and PowerPoint
- Experience with medical terminology and coding
- Strong interpersonal, organizational and analytical skills
- Ability to perform under pressure within rigid time constraints
- Willingness to continue educational course work and travel for training/business purposes
- Demonstrated ability to analyze situations and data
- Superior communication (written and oral), negotiations, teamwork, and organizational skills
- Ability to identify, establish and meet goals and objectives
- Language (Other than English): None
- Travel Requirement: 0% - 25%
Benefits
- (none explicitly listed)
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Healthcare administrationHealthcare financeMedical terminologyMedical codingData analysisContract managementNegotiationFinancial reimbursementThird party payment conceptsCompliance monitoring
Soft skills
Interpersonal skillsOrganizational skillsAnalytical skillsCommunication skillsNegotiation skillsTeamworkAbility to perform under pressureGoal settingProblem-solvingAdvocacy
Certifications
Certified Public Accountant (CPA)
