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J183506

Managed Care Contract Specialist

Allegheny Health Network

  • Company AHN
  • Pittsburgh, PA
  • Legal
  • Full time
  • Day (United States of America)

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

This job ensures that all contracting and payor credentialing activities are completed, accurately and timely, and provides organizational support to the Managed Care department.            

ESSENTIAL RESPONSIBILITIES

  • Processes payor contracts for single case agreements timely and accurately.  Continually follows up on agreements until complete and ensures contract compliance.  Collaborates with Allegheny Health Network (AHN) Revenue Cycle and Managed Care team to ensure proper billing and timely follow-up on single case agreements. (30%)
  • Completes and submits facility credentialing and re-credentialing applications with all payors accurately and in a timely manner.  Resolves credentialing issues through collaboration with management, related departments, insurers and others as identified. (20%)
  • Coordinates special projects and provides organizational support for the Managed Care department.  Ensures that project deadlines are met and project documentation is maintained appropriately. (20%)
  • Administers the Contract Repository System and ensures that Managed Care Contracts are stored timely and accurately into Contract Repository system.  (15%)
  • Maintains payor communication distribution list and disseminates pertinent payor announcements to AHN stakeholders. (15%)
  • Performs other duties as assigned or required.


QUALIFICATIONS:

Minimum

  • Bachelor's Degree in Business or related field
  • Project Management experience
  • Advanced computer skills using Microsoft Office (Word, Excel, and PowerPoint, Adobe, etc.)
  • Substantial organizational skills, including multitasking and time-management
  • Reliable customer service, follow-up, and communication skills
  • Ability to work effectively both independently and as part of a team
  • Continuously searches for process improvements to achieve accuracy and efficiencies
  • Strong critical thinking, problem solving abilities, and attention to detail


Preferred

  • 1 year in Managed Care  


Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

EEO is The Law

Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity ( http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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