Network Contract Analyst

🕒 Julho 6

🔔 Pennsylvania – Remoto

🔔 Pennsylvania – Remote

💵 $63.350 - $119.390 / ano

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

🧐 Analista

🚫👨‍🎓 Sem graduação necessária

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

👻 Score fantasma 27%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

Capital Blue Cross

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1938

🏥 Saúde

💼 Consultoria

🛡️ Seguros

Healthcare • Consulting • Insurance

A Capital Blue Cross é uma companhia de seguros de saúde que oferece uma gama de planos de saúde para indivíduos, famílias e empregadores. Eles atendem clientes na região central da Pensilvânia e no Vale de Lehigh, com foco em fornecer serviços de cobertura de saúde, como planos Medicare, planos de saúde estudantil e recursos para gerenciar cuidados médicos. A Capital Blue Cross se posiciona como uma parceira na saúde, enfatizando o apoio ao bem-estar geral dos membros e medidas de saúde preventiva.

Descrição

• Assist in developing the team’s annual plan based on resources and anticipated workload • Perform analytical functions to administer provider contracts • Prepare accurate provider contract settlements reflecting contract payment provisions • Develop anticipated provider settlements and support adequate Plan reserves • Manage the Cost Rate Adjustment process, including data accumulation, reconciliation, investigation, analysis, and Special Pricing Factor review • Suggest and help revise provider contract administration workflows • Respond to provider questions concerning contracts, claims, reimbursement, cost reports, ownership changes, and service locations • Resolve and document reimbursement issues and communicate conclusions through appropriate channels • Draft contracts for new providers and amend existing contracts • Analyze data supporting provider contract negotiations • Represent the team in cross-departmental Plan projects involving provider reimbursement and contracting • Research and evaluate State and Federal payment modifications, mandates, demonstration programs, and initiatives • Conduct analytical studies of billing patterns, charge description masters, and reimbursement provisions • Analyze retroactive and prospective provider reimbursement impacts • Develop analyses to monitor provider billing practice changes • Respond to and provide documentation for internal and external claim payment audits and surveys • Coordinate configuration and implementation of professional provider pricing schedules and fee exception calculations • Audit work performed by others in Provider Operations • Assist with maintenance of pricing schedules aligned with network strategies

🎯 Requisitos

• 2-3 years’ experience in a health care environment with proven analytical expertise is desired • Prefer a Bachelor's Degree in accounting, business administration, health planning and administration • Associate’s degree with sufficient level of work experience in health care or health care insurance pertaining to reimbursement or finance • Knowledge of Capital BlueCross provider contract provisions • Experience with Microsoft Office Suite, Access, Excel, Word, Crystal Reports, Tableau, and SAS • Intermediate Access skills including query development, table joins and formulas • Intermediate Excel skills using formulas, pivot tables and other functions/formulas • Working knowledge of claim and/or Facets data elements • Familiarity with provider claims submission requirements and reimbursement methodologies • Familiarity with Plan operations • Knowledge of general accounting practices and auditing procedures/techniques • Familiarity with Medicare and Medicaid reimbursement methodologies • Strong oral and written communication skills • Ability to work independently with minimal supervision and meet deadlines • Ability to perform provider contract analytics, data analysis, studies, and detailed reporting • Ability to understand database tables and data relationships • Ability to communicate professionally with provider financial personnel • Ability to manage multiple projects and priorities

🏖️ Benefícios

• Medical, Dental & Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible environment • Training and continuing education • Community volunteer opportunities