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Network Contract Analyst

AnalystAnalystOtherRemoteMid LevelTeam 1,001-5,000Since 1938H1B SponsorCompany SiteLinkedIn

Location

Pennsylvania

Posted

117 days ago

Salary

$63.4K - $119.4K / year

Seniority

Mid Level

Bachelor Degree2 yrs expExperience acceptedEnglishTableau

Job Description

Network Contract Analyst

Capital Blue Cross

• Perform contract administration activities encompassing preparation of contract settlements to ensure that claims are ultimately paid in accordance with the provisions of the contracts • Perform research, analytic and reporting work in support of the Provider Contracting and Value Based Programs ACA agreements, provider reimbursement strategies and new contracting initiatives • Work with team manager and other analysts to develop and administer contracts between Capital BlueCross and various providers • Assist in developing an annual plan for the team which considers available resources and anticipated workload • Responsible for the analytical functions necessary to effectively administer provider contracts • Prepare provider contract settlements ensuring accuracy • Manage the Cost Rate Adjustment process • Respond to questions and concerns raised by providers • Participate in drafting contracts for new and existing providers • Develop proactive analytical studies to assess changes in provider billing patterns and charge description masters • Perform audit functions on the work of others in the Provider Operations unit

Job Requirements

  • 2-3 years’ experience in a health care environment with proven analytical expertise
  • Prefer a Bachelor's Degree in accounting, business administration, health planning and administration or an Associate’s degree with sufficient level of work experience in health care or health care insurance pertaining to reimbursement or finance
  • Knowledge of Capital BlueCross provider contract provisions
  • Demonstrated knowledge of various tools such as Microsoft Office Suite products (Access, Excel, Word, etc.), Crystal Reports, Tableau, and SAS
  • Ability to perform at an intermediate skill level in Access including query development, table joins and formulas
  • Ability to perform at an intermediate level in Excel utilizing formulas, pivot tables and other functions/formulas
  • Familiarity with the operational aspects of different provider types with an understanding of their claims submission requirements and provider reimbursement methodologies
  • Knowledge of general accounting practices and auditing procedures/techniques
  • Familiarity with Medicare and Medicaid reimbursement methodologies (facility and professional providers).

Benefits

  • Medical, Dental & Vision coverage
  • Retirement Plan
  • Generous time off including Paid Time Off, Holidays, and Volunteer time off
  • Incentive Plan
  • Tuition Reimbursement
  • And more

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