Contract Management – Revenue Integrity Specialist

🕒 vor 23 Tagen

Jetzt Bewerben

Ähnliche Remote-Jobs finden

E-Mails für Remote-Jobs erhalten

📊 Überprüfen Sie Ihre Lebenslauf-Bewertung für diese Stelle

Verbessern Sie Ihre Chancen auf ein Vorstellungsgespräch, indem Sie Ihre Lebenslauf-Bewertung vor der Bewerbung überprüfen.

Lebenslauf hochladen

Nira Medical Group

WebsiteLinkedInAlle Stellen

51 - 200 Mitarbeiter

⚕️ Krankenversicherung

Healthcare Insurance

Die Nira Medical Group ist eine nationale Praxisplattform, die sich darauf konzentriert, die neurologische Versorgung zu transformieren, indem sie lebensverändernde Behandlungen für Patienten zugänglicher macht. Die Organisation unterstützt Neurologen, indem sie ein umfassendes Dienstleistungsspektrum bereitstellt, das es ihnen ermöglicht, erstklassige Versorgung zu bieten. Durch die Vereinigung erstklassiger Ärzte und das Arbeiten nach einem von Ärzten geführten Modell verbessert Nira Medical die Gesundheitsversorgung durch erweiterten Zugang und die Integration fortschrittlicher neurologischer Verfahren und Dienstleistungen unter einem Dach. Die Gruppe zielt darauf ab, den Verwaltungsaufwand für Gesundheitsfachkräfte zu reduzieren und umfassende Patientenversorgung, einschließlich zusätzlicher Dienstleistungen wie Infusion, klinische Forschung und Bildgebung, bereitzustellen.

Beschreibung

• Lead all new payer contract negotiations, managing the end-to-end process from initial outreach through execution, ensuring terms align with organizational goals and market benchmarks. • Establish and maintain fee schedules and contracted rates for professional services, drug/pharmacy, and ancillary services. Own rate-setting decisions in collaboration with Finance and clinical leadership. • Maintain, update, and audit all payer allowable tables within Athena and any other relevant systems. Coordinate quarterly or monthly allowable schedule pulls based on payer requirements and internal cadence needs. • Identify, track, and resolve payment variances resulting from a mismatched allowable between contracted rates and actual payer remittances. Partner with billing and RCM teams to correct discrepancies and prevent recurrence. • Serve as the primary point of contact for payer inquiries and projects related to contract pricing. Facilitate timely resolution of payer-initiated issues and proactively surface risks to leadership. • Generate and distribute regular reporting on contract performance, allowable schedules, out-of-network activity, and no-go status. Ensure leadership has the visibility needed for strategic decision-making. • Conduct out-of-network analyses to evaluate financial exposure and inform contracting strategy. Maintain and distribute no-go reporting to flag payers or services where participation is not financially viable. • Manage all updates within Athena related to contracts, allowable updates, payer configurations, and rate changes. Ensure system accuracy is maintained continuously, and changes are tested and validated upon implementation.

🎯 Anforderungen

• Associate’s degree in healthcare administration, business, finance, or a related field; or equivalent relevant experience in payer contracting or revenue integrity • Minimum 3–5 years of experience in payer contracting, allowable management, or revenue integrity roles • Strong understanding of fee schedule structures, payer reimbursement methodologies, and contract terms across professional, drug/pharmacy, and ancillary service lines • Demonstrated experience managing allowable tables and rate configurations within Athena EHR or similar practice management systems • Proficiency in identifying and resolving payment variances and mismatch allowable • Experience with out-of-network analysis and no-go reporting frameworks • Excellent analytical and problem-solving skills with high attention to detail • Strong communication and negotiation skills; comfortable interfacing directly with payer representatives • Ability to manage multiple priorities and deadlines in a fast-paced, growth-oriented environment • Experience working in a multi-specialty, multi-location healthcare organization preferred • Athena EHR experience strongly preferred; experience with MSO structures a plus

🏖️ Vorteile

• Health insurance • Flexible work arrangements