Terms & Condition Analyst

  • Tenet
  • Detroit, MI, USA
  • Mar 17, 2019
Full time Other

Job Description

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! JOB SUMMARY The Contracts Analyst is responsible for healthcare insurance reimbursement analysis; validating pre-load and post-load of contracts; applying independent judgment in the maintenance of the claims adjudication system; formulating and implementing system improvements, acting as a subject matter expert during contract negotiation processes, making recommendations to the Managed Care negotiators regarding terms of the contract; and collaborating with key stakeholders for the resolution of related issues. The Contracts Analyst responsibilities ultimately affect the business operations to a substantial degree. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. Analyzes the Contract Terms and Conditions in a timely manner and makes recommendations for new contract loads, formulates and implements amendments and changes, and rollover contracts as part of the client audit, deviating from established procedures as necessary. Regularly exercises discretion in analyzing and identifying issues associated with reprice impact reports after communication log issue have been corrected and re-priced. Formulates and implements solutions to identified issues and is empowered to make exceptions when required to move issues to resolution. Independently audits and verifies post-contract changes. Collaborates with Client Managed Care and Med Assets Account Rep to ensure contract profiles are pricing accurately, per contract language. Reviews internal requests for assistance and executes work list/queries for newly opened communication logs. Documents affected accounts as required. Identifies alternative opportunities in contract interpretation and revenue routing through the analysis of issues and, acting as a subject matter expert, provides alternative recommendations to management and staff. Activation of plan ID's in mainframe system and MedAssets complying with NIC standards. Request approvals from Managed Care for NCCI edits if stated in contract and forward to the appropriate parties for loading. Communicates with appropriate leadership to ensure discrepancies are resolved prior to close of month end.

Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.