Mercy Health

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Contract Specialist

Contract Specialist

Requisition ID 
2017-747299
Category 
Support Services
Position Type 
Full Time
Shift(s) 
Days
Department 
Division Of Managed Care
Location 
US-MO-Springfield

More information about this job

Overview

Job Template Header

 

We’re a Little Different

 

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.  

 

We don’t believe in jobs at Mercy, we believe in careers that match the unique gifts of unique individuals; careers that not only make the most of your skills and talents, but also your heart.

 

At Mercy, you’ll feel our supportive community every step of your day, especially the tough ones. We’re a team and love working that way. That team is expanding, and we currently have exceptional opportunities to help our communities grow.

 

Responsibilities and Qualifications

Orients physicians and their office staff, hospitals and other ancillary providers on the benefits and contractual obligations of all plans. Assists offices in understanding managed care, credentialing, utilization management, and related issues to promote positive environment for the Health system members across product lines.

Interacts with managed care plan representatives regarding claims issues and other contractual issues.

Works closely with the Director, Health Plan Operations and/or Manager, Provider Contracting.

Updates managed care plans on provider changes, additions and deletions on a monthly basis.

Maintains contractual information in the Contract Reference Guide.

Update the Access and Availability Report.

Update the HSD report.


Updates PHO Representatives, individual network affiliates and provider organizations on new contracts and contract changes on a monthly basis.

Recognizes issues and uses problem solving to identify inconsistencies in the way we process information and claims, develop alternatives, including new policies and procedures, letters, memos and presentation materials.

Initiates visits to providers when member services, claims or utilization management, etc. Identify issues which require intervention. Assists in reviewing, researching and answering written correspondence from providers.

Documents all external interactions and reports regularly to the Director, Health Plan Operations.

Leads and supports special projects as required.

Maintains contractual information in MediTract and the Online Matrix.

Enter and track fee schedules in the Provider Fee Schedule Database.

Enter and track claim issues in Call Log.

Maintain compliance with HIPAA regulations.

Observes universal precautions consistently.

Wears proper personal protective equipment when appropriate.

Wears clothing and Health System badge consistent with dress code, and attends to personal hygiene to maintain a clean, well-groomed appearance.

Meets Health System attendance standards.

 

Qualifications:

Each career at Mercy represents unique members of our caring ministry’s “body”, working together for the health and strength of the whole. To achieve our goals, we need all the parts functioning at their best and this requires the specific qualifications that you’ll bring with you:

 

  • Education: High school diploma or equivalent.
  • Licensure: Valid U.S. Driver’s License and car.
  • Experience: One to three years managed care or health care experience desired with ability to develop and perform.
  • Other: Skills, Knowledge, and Abilities: Understanding of physician office procedures, medical terminology and/or HMO benefits desired. Familiarity with CPT4, ICD9 and UB92 coding desired. Requires a highly self-motivated and independent worker who is able to develop and keep own schedule, is able to prioritize assignments and design programs to meet the needs of individual groups and/or offices. Strong interpersonal and communication skills with the ability to design tools which will be useful in educating office staffs and physicians in issues related to Managed Care. Excel or Access knowledge helpful. Working Conditions, Mental and Physical Requirements: Ability to travel within a defined service area.
  • Preferred Education: Prefer some vo-tech or college credit.
  • Preferred Experience: Previous Physician Office or Insurance Company experience in filing/coding claims preferred.

 

 

We’ll Support You at Work and Home

 

Our foundations are built on dignity and respect. Modern Healthcare Magazine named us as a “top 100 places to work.” We go out of our way to help people feel welcomed. We offer day-one comprehensive health, vision and dental coverage, PTO, and employer-matched retirement funds, even to part-time employees. We’re proud to provide tuition reimbursement to help you grow and learn new skills.

 

What Makes a Good Match for Mercy

 

Compassion and professionalism go hand-in-hand with us, along with exceptional quality care. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We’re also collaborative and are not afraid to do a little extra to deliver excellent care – that’s just part of our commitment. If that sounds like a fit for you as well, we encourage you to apply.

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