Contracts and Reimbursement Specialist
Company: Central California Faculty Medical Group (ccfmg) A
Posted on: January 13, 2022
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.
- Initiates fee for service and managed care contracts,
amendments and extensions.
- Draft language to address unique situations/concerns for review
- 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
- Monitors contracts for accurate reimbursement and communicates
- 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
- Combines knowledge of data residing in practice management
system(s) and other reporting tools to report and evaluate contract
- Quarterly reimbursement sampling with identification and
resolution of claims and payments not meeting contract
- 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
- 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
- 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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