📁
Finance
💼
Cottage Health
📅
190001E1 Requisition #

This position will provide support for organization-wide contracting and managed care initiatives, data reporting and analytics, and administrative functions. Key roles will be in, but not restricted to, data analysis in specialized claims warehouse for employee health plan; preparing non-complex contract models; facility credentialing; contract-related insurance compliance; assessing and maintaining a contract database, facilitating contract approval; selected vendor analysis and billing validation; assisting in committee meeting preparation.


MAJOR ACCOUNTABILITIES / SPECIFIC JOB COMPETENCIES


1. Contract Administration: Upload new and amended executed contract documents to online database ensuring that all rates and terms are correct and meet with intent; evaluate, maintain, and update vendor certificates of insurance and provide Cottage insurance certificates; upload clinical contract reviews, regularly evaluate system reminder dates; upload and track consumer price index increases and options for all contracts; Contract database analysis, clean up and maintenance; prepare finalized contracts for execution via DocuSign ensuring all agreed upon language and rates are in the signature ready document as well as all the correct demographic information; communicate with vendors throughout the contracting process; review contracts ensure contract cover pages are correct and completed, initiate vendor setup requests for new contracts, provide follow up communication to vendors with purchase order information.


2. Managed Care Duties: Review and audit patient transport invoices; review, validate and track payor disallowed charges notifications, complete hospital surveys and quality program applications; complete hospital credentialing applications; maintain required documents for hospital re-credentialing; coordinate payor meetings; monitor and analyze value based contract performance; support strategic contracting initiatives as needed; assist in contract review and preparation; track and trend value based initiatives; other duties as assigned.


3. Accountable Care Organization: Assemble ACO Board packages and other administrative functions as needed; gather and assemble ACO data and reporting for Committees, Board and skilled nursing facility (SNF) providers; use a data mining tools to review and gage ACO and provider performance; coordinate SNF meetings for the ACO.


4. Employee Health Plan Contracting: Evaluate and maintain roster of contracted providers; track credentialing for physicians and provider groups; communicate with internal stake holders to coordinate credentialing and contracting; send new contract packets and track through contracting process; ensure network adequacy and explore new contracting opportunities in the market; review/maintain health plan fee schedule; gather and assemble data and reporting for Physician meetings and Care Coordination agreement obligations; prepare and review invoices for the Care Coordination agreements; gather and assemble financials for the Care Coordination agreements including year-end reconciliations.

 

QUALIFICATIONS


LEVEL OF EDUCATION


Minimum: AA or equivalent experience where 2 years of applicable work experience is equal to 1 year of education.


Preferred: BA or BS degree


TECHNICAL REQUIREMENTS


Minimum: Intermediate MS Excel, and Basic MS Word and PowerPoint Experience with database management Basic understanding of modeling/finance, legal and contracting principles


Preferred: General understanding of contracting in a healthcare environment, and a general understanding of managed care concepts.


YEARS OF RELATED WORK EXPERIENCE


Minimum: 1 year experience in a professional work environment either working with contracts, or finance, or legal, or insurance


Preferred: 2-3 years' experience in healthcare related field.

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