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Contracts and Reimbursement Specialist

Company: Central California Faculty Medical Group (ccfmg) A
Location: Fresno
Posted on: January 13, 2022

Job Description:

The position is responsible for facilitating the development and analysis of contract terms and conditions. The responsibilities include tracking and updating of medical service contracts and maintaining appropriate records of these activities. In addition, the Contract Specialist will analyze financial information from various systems and work closely with operational departments to ensure the success of contract performance and work through disputes with payers. This position may assist with other special projects as assigned.
JOB FUNCTIONS:

  • Initiates fee for service and managed care contracts, amendments and extensions.
  • Draft language to address unique situations/concerns for review by Leadership.
  • Evaluates rates and requirements of proposed contracts and brings forth recommendations to leadership.
  • Provides notification to management group of approaching expiration of contracts with recommendation to continue, amend or terminate contract based on historical reimbursement and current rates.
  • Monitors contracts for accurate reimbursement and communicates trends.
  • Develops and maintain a contract database.
  • Provides assistance with issues related to payer requirements, claims, and reimbursement rates
  • Responsible for communicating information regarding current, new or amended contract(s) terms, to the appropriate departments
  • Combines knowledge of data residing in practice management system(s) and other reporting tools to report and evaluate contract performance
  • Quarterly reimbursement sampling with identification and resolution of claims and payments not meeting contract reimbursement rates.
  • Keeps abreast of industry trends related to physician contracts and recommends change as needed.
  • Aware of operational changes as it relates to contracts.
  • Maintains and updates contracting dashboard
  • Performs other special projects/assignments needed to support the organization.
  • Serve as a relationship liaison with payers in the market.
  • Monitor all aspects of the relationship to ensure appropriate communication and contract compliance
  • Financial modeling specific to contracting efforts, ensuring negotiated rates meet desired objectives
  • Assist with business development
    Requirements
    • Bachelor's degree or equivalent combination of education and related work experience.
    • Minimum four years related work experience, preferably in a medical or hospital setting.
    • Three years health related work experience concerning contracting, payment/reimbursement methodologies.by Jobble

Keywords: Central California Faculty Medical Group (ccfmg) A, Fresno , Contracts and Reimbursement Specialist, Other , Fresno, California

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