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J191167

Managed Care Contract Analyst

Allegheny Health Network

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

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

This job ensures that Managed Care Contracts are loaded timely and accurately into Contract Management software. Monitor and manage payment variances for assigned payors. Provide timely and accurate information regarding payor reimbursement methodologies, rates, policies, etc.

ESSENTIAL RESPONSIBILITIES:

  • Investigate discovered payment variance for contract non-compliance. Pursue payment with payor representatives for assigned payors.  (40%)
  • Ensure that contracts are properly and timely loaded into Contract Management for assigned payors. (20%)
  • Complete reimbursement analysis as assigned (e.g. month end estimations and new product requests). (20%)
  • Research payor information regarding reimbursement methodologies, rates, policies, etc. for education and distribution to AHN internal departments. (15%)
  • Collaborate with Revenue Cycle, Finance, and other departments on Managed Care Payer and system issues. (5%)
  • Perform other duties as assigned or required. 

QUALIFICATIONS:

Minimum

  • Proficiency in Excel
  • Applicable certification or proficiency in contract modeling software
  • 1 year in Healthcare Finance, Patient Financial Services, Managed Care, Healthcare Reimbursement, Healthcare Cost Accounting or Healthcare Decision Support

​ 

Preferred

  • Bachelor's degree in Business, Finance, or Healthcare
  • Managed Care Experience

  • HB or PB Contract Management

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.

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, age, 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, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.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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