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Emerus Holdings, Inc. · 10 hours ago

Contract Specialist | Managed Care

United States

Contract

Remote

Senior Level

5+ years exp

Emerus Holdings, Inc. is the nation’s first and largest operator of small-format hospitals, and they are seeking a Contract Specialist to support managed care needs. This role involves maintaining contract databases, financial analysis, and resolving contract payment disputes while collaborating with various departments.

Health CareHealth DiagnosticsService Industry

Responsibilities

Managed care liaison for and “subject matter expert” of the company’s joint venture hospital partners, revenue cycle billing and collections team, and finance department leads

Prepares, compiles and consolidates payor performance metrics data for reporting to organizational leadership

Maintains a managed care contract database to aid in streamlining collections activity, analysis and the dissemination of contract details and terms

Supports the company’s revenue cycle team by loading and maintaining up to date contracted payor rates in an insured allowed/payment validation collections module

Conducts random audits on claim payment activity to ensure payors are honoring the agreed to terms within their managed care agreements

Provides support for special projects which include but are not limited to, collecting and analyzing claim data needed for contract negotiations, additional service line research and pro forma assistance with new market opportunities

Develops contract models to evaluate current contract performance yields and new contract proposals

Partners with revenue cycle team members to identify and establish an inventory of underpaid and overpaid claims so initiatives can be implemented to secure proper payment

Supports finance team’s annual budget development with managed care assumptions and contract modeling of rate escalators, charge master updates and new contact revenue yields

Supports the organization’s revenue recognition team as needed with month end close activities by providing managed care’s perspective on key items or initiatives that influence recorded revenues

Managed care representation in joint venture board meetings as needed

Performs other financial data gathering and analysis related to internal and external user’s needs and requests

Researches and responds to inquiries from management

Provide explanations and recommendations of the subject matter

Participate in cross-functional business projects, specifically with finance, Operations, Revenue Cycle, and Business Development, and perform ad hoc analysis as required

Attend staff meetings or other company sponsored or mandated meetings as required

Perform additional duties as assigned

Qualification

Financial modelingData analysisHospital payment methodologiesMicrosoft Office SuiteContract modelingAnalytical skillsProblem-solving skillsOrganizational skillsCommunication skillsDetail-orientedSelf-starterWork independently