Delaware First Health · 6 hours ago
Contract Implementation Analyst
Texas, United States
Full-time, Contract
Remote
Entry Level
$22.36/hr - $38.07/hr
1+ years exp
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Responsibilities
Perform day to day duties and testing of contract implementation, including UAT to ensure that systems accurately reflect a contract's negotiated terms.
Analytical skills to assess data, identify patterns, and troubleshoot claims issues.
Knowledge of healthcare coding (ICD, CPT, HCPCS) and payer-specific rules.
Problem-solving abilities to address complex configuration and claims issues.
Work with internal teams to set up systems (CRM, ERP, etc.) to reflect contract details, such as pricing, terms, and deliverables.
Assist in the development of tools or templates to streamline the contract implementation process.
Conduct quality checks to ensure contract implementation is accurate and complete, including resolving any discrepancies.
Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing.
Review and price contract related pends to ensure claims payment accuracy.
Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (CRs) (i.e.RHCs/FQHCs/fee schedule updates).
Troubleshoot and problem solve contract implementation issues related to basic system configuration.
Review contracts and assign pay classes and applicable provider information based on contract language.
If configuration is needed to accommodate a contract, notify the appropriate parties.
Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments.
Review new and current provider contracts and established state guidelines.
Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plan, claims and corporate management and information systems staff.
Qualification
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Required
Bachelor’s degree in Business, Finance, related field, or equivalent experience.
1+ years of provider contract implementation, contract analysis or claims analysis experience in managed care, health care or TPA setting.
Analytical skills to assess data, identify patterns, and troubleshoot claims issues.
Knowledge of healthcare coding (ICD, CPT, HCPCS) and payer-specific rules.
Problem-solving abilities to address complex configuration and claims issues.
Work with internal teams to set up systems (CRM, ERP, etc.) to reflect contract details, such as pricing, terms, and deliverables.
Assist in the development of tools or templates to streamline the contract implementation process.
Conduct quality checks to ensure contract implementation is accurate and complete, including resolving any discrepancies.
Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing.
Review and price contract related pends to ensure claims payment accuracy.
Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (CRs) (i.e.RHCs/FQHCs/fee schedule updates).
Troubleshoot and problem solve contract implementation issues related to basic system configuration.
Review contracts and assign pay classes and applicable provider information based on contract language.
If configuration is needed to accommodate a contract, notify the appropriate parties.
Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments.
Review new and current provider contracts and established state guidelines.
Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plan, claims and corporate management and information systems staff.
Preferred
Government programs and Amisys experience.
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
Delaware First Health
Delaware First Health offers Medicaid-managed care plans, improving individual and community health and wellness.
1 employee
Funding
Current Stage
Early StageLeadership Team
Bill Wilson
Plan President and CEO
Tiffany (Aany) Tazmin-Ewing, FSA, MAAA
Chief Financial Officer
Company data provided by crunchbase
