Contract Resolution Specialist

🔥 12 hours ago

🏰 Missouri – Remote

🏰 Missouri – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CoxHealth

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1906

🏥 Healthcare

🧘 Wellness

📚 Education

Healthcare • Wellness • Education

CoxHealth is a regional, not-for-profit integrated health care system serving southwest Missouri, operating hospitals, urgent care centers, clinics, specialty services (including cardiology, cancer care, orthopedics, neurology, and pediatrics), home health, and ancillary services. With hundreds of physicians, extensive outpatient locations, training and residency programs, and community-focused patient resources, CoxHealth provides comprehensive clinical care, patient support services, and health education to individuals and families across the Ozarks.

📋 Description

• Assist network providers with contractual issues • Act as a trainer/educator on CoxHealth Network contracts for network providers and their staff • Organize and host meetings when required • Perform initial and recredentialing on-site reviews and chart audits for providers as needed • Resolve contracts and deliver and interpret policy and procedure changes related to specific contracts • Communicate regulatory changes related to the insurance industry as needed • Research new technology related to payors' medical necessity and coverage • Maintain contacts and provide educational information to network, tertiary/affiliate PHO networks impacting over 3,000 providers/facilities • Organize, prioritize, and multitask to execute projects and daily workflow

🎯 Requirements

• High School Diploma or Equivalent • 3-5 Years experience working in the provider office, healthcare billing, healthcare insurance and/or Managed Care industry • Ability to understand complex multi-provider payor contract agreements and determine compliance standards are being adhered to • Must be a self-starter and work with minimal supervision • In-depth working knowledge of managed care plans and CoxHealth contracts • Understanding of the legality of the messenger process used for independent providers • Ability to analyze and communicate contractual terms and requirements to providers • Local travel required • Preferred: Bachelors in a Related Field • Preferred: Previous experience in provider relations and/or physicians office management

🏖️ Benefits

• Medical, Vision, Dental • Retirement with Employer Match • Benefits eligibility for employees working 20+ hours/week