Provider Contract Analyst

The Provider Contract Analyst at Helion manages post-acute care contracting, focusing on home health, hospice, and skilled nursing facilities. The role involves contract lifecycle management, negotiations, compliance, and provider-facing activities, with a preference for candidates in Western, PA.

Location: Remote (US)

Salary: $68,400–$105,900/yr

Responsibilities

• Monitor activities by tracking the specific terms of each contract and maintaining some mechanism for monitoring and documenting compliance with those terms. Perform special studies/audits, coordinating office site visits and medical records reviews, ensuring resolution of member/provider complaints in timely manner.
• Prepare periodic reports that summarize compliance with key responsibilities outlined in the agreement for both internal and external audiences. Conduct, collect and analyze data from claim and/or medical record reviews to continually improve the care and service to members and coordinate with the financial recovery areas to retract erroneous or inappropriate payments.
• Manage contracts including negotiations, contract development, contract renewal, and financial reimbursement.
• Act as the intermediary between the organization and outside entity to ensure all responsibilities as outlined in the contract are fulfilled. Serve as an advocate for managing expectations to achieve positive outcomes. Participate in educational and training sessions for provider billing staff to ensure understanding of and compliance with proper guidelines.
• Provides control and processing support for final provider settlements and initiating, documenting, processing, and establishing collection protocols for provider settlements.
• Work with sales and customer service to respond to questions/inquiries from customers/members related to appropriateness of services billed by providers. Consults with Medical Director on questions/issues related to medical necessity and appropriateness of services.
• Other duties as assigned or requested.

Requirements

• Associates degree in Business, Finance, Information Management, Healthcare Administration or Health Related Discipline

Additional Information

• This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
• Employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. All employees must comply with HIPAA and company data security policies.