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Sharp HealthCare · 2 days ago

Contracts Analyst - SCMG Capitation Administration - Corporate Office - Day Shift - Full Time

San Diego, CA

Full-time

Onsite

Mid Level

$32.73/hr - $45.81/hr

3+ years exp

Sharp HealthCare is a leading healthcare provider seeking a Contracts Analyst to support their SCMG Capitation Administration. The role involves analyzing contractual terms, ensuring accurate system setup, and providing data and financial analysis for healthcare providers.

Health CareNon Profit

Responsibilities

Responsible for requesting, preparing and analyzing data necessary for contract negotiations; develop reports necessary to determine contract performance compared to budget or established standards

Assist in the development and maintenance of communication links throughout SCMG and Sharp system to identify reimbursement issues and participation in the development of action items for resolution

In addition, communicate current contract information

Provides feedback to the SCMG Contracts team as it relates to required contractual changes to ensure compliant and timely claims processing and reimbursement

Responsible for generating SCMG Contract Verification Form (CVF) document for every contract addition, change and termination

Assures contract information is communicated and coordinated to appropriate internal departments and audit is performed to ensure accurate contract claim/encounter pricing and other reimbursement terms are in effect

Creates and maintains the contract matrices for the system setup and ensures proper claims adjudication in collaboration of the Epic/Tapestry claims support team, which includes auditing Epic/Tapestry claims system set up to verify appropriate and correct reimbursement

Keeps SCMG abreast of Epic/Tapestry system updates and changes as it relates to the processing of professional claims

Monitors provider reimbursement issues regarding any contract disputes and report to the Contracts Manager

Performs ongoing and ad hoc audits of the claims processed to ensure accuracy and appropriateness of claims payments and denials

Perform quarterly audits of contract reimbursement performance in relation to contract terms for ancillary, primary and specialty care providers

Provides support for regulatory claims audits to the various SCMG departments and the Sharp HealthCare claims department

Provides support to the Appeals and Grievances team as it relates to claims processing and the Epic/Tapestry setup

Assists in project coordination with other SCMG departments: Claims, Utilization Management, Network Management and Pharmacy Benefits

Maintains service orientation to representatives of SCMG through consistent assessment of needs and timely response to requests

Develops and maintains relationships with contract representatives in support of SCMG and ensure timely response to contractual issues and contract compliance problems

Assists with other duties as assigned to be completed in an agreed upon format and in an agreed upon time frame

Qualification

Healthcare claims experienceManaged Care experienceEpic/Tapestry experienceCPT/ICD 10 codingClaims processing knowledgeAnalytical skillsRelationship managementCommunication skills

Required

3 Years experience with healthcare claims, reimbursements, and/or contracts

2 Years experience in a Managed Care environment

Bachelor's degree in business, accounting, or healthcare administration; or 4 years of relevant experience in contract or claims administration may substitute for degree