Managed Care Contract Analyst, Corporate Greenville, FT, Day

Company: Prisma Health
Location: Greenville
Posted on: January 26, 2025

Job Description:

Inspire health. Serve with compassion. Be the difference.Job SummaryCoordinate system-wide hospital and physician services contracting, including but not limited to, strategy formulation, contract terms and contract performance. Coordinate the implementation, presentation and servicing of all contracts for the entire system. Provides system wide managed care education and communication.Accountabilities

• Coordinate the processing of all payer contracts and amendments. Coordinate all the steps required in the development, review and processing of new contracts, contract renewals and contract amendments with payers. Coordinate all required steps for the execution of contracts and amendments and ensure completion or execution of finalized contracts and amendments within specifiedtime framesor deadlines. Perform detailed review of the business terms in contracts and amendments received from payers, identify unacceptable terms and recommend revised terms that meet the needs of Prisma Health. Negotiate single case agreements when necessary.40%
• Perform detailed analyses of the financial and operational impact of procedural changes implemented by payers.10%
• Develops and maintain contracting decision making and tracking tools.10%
• Develops model contracts or contract language for use in proposing contract or amendments to payers. Establish reporting techniques that will identify areas of concern and prepare recommendations to address any issues.15%
• Provide problem solving support to Prisma Health affiliates and departments. Work closely with payers to ensure that Prisma Health receives all provider manual changes, provider bulletins, benefit plan changes and other payer documents. This position distributes this information throughout Prisma Health in a timely fashion. Conduct pro-active communication, contract compliance, and educational sessions. Develop and maintain effective relationships with payers and internal customers25%Supervisory/Management Responsibilities
  • This is a non-management job that will report to a supervisor, manager, director or executive.Minimum Requirements
    • Bachelor's Degree.
    • 5 years-Managed-care experience, preferably in a contracting or provider relations role.Required Certifications/Registrations/Licenses
      • N/AIn Lieu Of The Minimum Requirements Listed Above
        • In lieu of manage care experience, fie years experience in healthcare administration, health insurance, or provider contracting.Other Required Sills and Experience
          • Knowledge of the health-insurance industry, specifically managed-care contracting operations and negotiation techniques- RequiredWork ShiftDay (United States of America)LocationPrisma Health Corporate OfficeFacility7001 CorporateDepartment70019069 Managed Care ContractingShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

Keywords: Prisma Health, Columbia , Managed Care Contract Analyst, Corporate Greenville, FT, Day, Professions , Greenville, South Carolina