Managed Care Contract Analyst

🔥 9 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 12%

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.

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Prisma Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Prisma Health is a comprehensive health care provider offering a wide range of medical services to ensure individuals achieve their healthiest state. With numerous locations, advanced technology, and expert specialists, Prisma Health provides accessible and convenient care. Services include primary care, specialized heart, cancer, women's, and children's health, as well as same-day and telehealth options. Prisma Health emphasizes community outreach and education to support overall health and wellness.

📋 Description

• Coordinate system-wide hospital and physician services contracting initiatives and contract management • Formulate contracting strategy and manage contract terms and performance • Coordinate implementation and servicing of contracts across the entire system • Assist with system-wide managed care education and communication • Review contract language and recommend language, reimbursement changes, terms, and provisions with payors • Coordinate and assist in processing payer contracts and amendments within specified time frames • Implement contracts and amendments with team members and internal departments • Track and monitor contracts, amendments, and renewals in a database • Provide problem-solving support to affiliates and departments • Obtain and distribute payer manual changes, bulletins, benefit plan changes, and other payer documents • Conduct proactive communication, contract compliance, and educational sessions • Develop and maintain relationships with payers and internal customers • Analyze the financial and operational impact of procedural changes implemented by payers • Develop and maintain contracting decision-making and tracking tools • Participate in special projects assigned by the Director or Vice President of Contracting • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in Business or a related field • Three (3) years of managed-care experience • Experience in a contracting or provider relations role preferred • In lieu of the education and experience requirements: high school diploma and five (5) years of managed care experience in healthcare administration, health insurance, provider contracting, or a related field may be considered • Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques • Knowledge of office equipment (fax/copier) • Proficient computer skills (word processing, spreadsheets, database) • Mathematical skills