Analyst (Provider Contract)

Posted: 06/19/17 | SHARE:

Description:

Review and revise network contracts with legal, distributes and maintains contract templates in a centralized contracting database, and develop implementation plan to deploy contract changes in order to support all PR regions of MVP Healthcare. Compile data analysis to support key business objectives and product objectives where contract management initiatives are involved. Attends C-series meetings to keep apprised of nonstandard contract changes and nonstandard rate approvals. Management of fee schedules in conjunction with BSC and Informatics. Distributes and maintains contract templates in a system repository for all PR Managers to access. Process new provider contract requests and preparing CAQH applications and documentation and ensures effectiveness of the flow of information from Credentialing through the contracting process to the final data entry into the claims processing system. Tracks all new provider contracts and applications for credentialing and provides weekly status reports for Professional Relations. Provides follow-up requests for information to provider offices and collaborates with members of the Professional Relations Department to obtain site visits and missing information from providers when necessary. Reviews Credentialing Committee lists and performs quality control of all provider contract effective dates, networks, and demographic information in Cactus and Facets. Scanning of contracts and site visits into system for compliance obligations. Oversee the provider welcome letter process and mailing of executed contracts to providers. Coordinate and prepare documentation for audit requests including but not limited to CMS, DOH, DFS, IBM, SSAE-16, Financial (SAS-70), and MARh. Prepare and submit provider network information for Requests for Proposals (RFP) or Requests for Information (RFI). Assists in special projects by preparing and coordinate documentation for tasks related to contracting and network expansion as directed by management. Performs other duties as assigned.

Qualifications:

-Working knowledge of relational databases including querying and reporting. Working knowledge of Microsoft Office applications. Intermediate to advanced Excel skills including intermediate formulas.
-Ability to organize and present data effectively; detail oriented.
-Strong Interpersonal skills and ability to work independently and prioritize to meet deadlines; internal and regulatory.
-Strong organizational, time management, oral, written and communication skills.
-Must have a high degree of personal initiative and ability to work independently.
-Attention to detail including accuracy, spelling and calculations.
-A team player able to work well in an energetic, dynamic and deadline oriented environment.
-Previous experience required in situations demanding strict adherence to confidentiality.

Minimum Education:

BA/BS Degree preferred or Associates Degree with equivalent combination of experience considered.

Minimum Experience:

1-2 years’ work experience in an analytical environment with problem solving responsibilities. Experience in contract generation and/or legal support preferred.

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