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Contract Specialist

Position Summary:

The Contract Specialist will effectively analyze, resolve and track payer denials associated with changes due to contractual differences, obtain Single Case Agreements and pursue provider contracts. This position provides support to both the Funding Specialists and Billing teams in addition to other Contracting Specialists. The Specialist will assist in identifying areas for continued process improvements that will further decrease new denials and write-offs. The person can enter information into Infor, MyForms and Brightree to ensure compliance with Medicare, Medicaid, and insurance requirements. The employee will be responsible for issues that occur across the United States.

Activities, Duties, and Responsibilities:

•  Maintains company policy and product knowledge.
  • Reflects professionalism at Prentke Romich by keeping up to date on product and peripheral capabilities that fit into product lines.
  • Understands relationship between Prentke Romich products and related industry products. 
  • Is knowledgeable on medical billing codes and payment procedures.

Key Responisibilities and Competencies

• Obtain necessary Single Case Agreements and Contracts.
  • Complies with corporate policy to initiate single case agreements within two business days of request.
  • Contact provider via email or phone to request SCA or contract.
  • Negotiate with provider to obtain SCA rates or contract that meets PRC reimbursement requirements.
  • Communicate with other Contract Specialists to review SCA and contract requests and concerns.
  • Record SCA and contract discussions and agreements in appropriate software and communicate results to necessary team members.
  • Must be proactive in flagging potential SCA or contractual issues before they occur.
  • Understand PRC order management and billing processes and policies.
  • Activities (electronic follow-ups) are established for next process.
  • Researches, applies and enters new provider information into billing and funding software and ensures electronic billing is established for all payers.
• Reviews submissions and claims for potential denial issues related to contractual differences.
  • Reviews submission requests (prior to shipments) where SCAs cannot be obtained to ensure payment is received once the device ships.
  • Reviews submission requests for funded packets that are flagged as high risk payments.
  • Schedule meetings with appropriate internal resources to review and makes judgment calls on how to move forward.
  • When necessary, research provider manuals or other medical reference guidelines to establish payment risk
• Analyze and research cases, applying critical thinking, independent judgment, and business sense to resolve and prevent denials
  • Track and communicate payer trends and reimbursement changes across the U.S., by payer, by state and by industry (Medicaid, Insurance, etc)
  • Display an outward commitment to departmental revenue goals
  • Responds via mail, fax, or email to provider inquiries. Relays updated information regarding provider policy changes, etc. to the funding and billing departments.
  • Maintains confidentiality outlined in privacy portion of the federal Health Information Portability and Accountability Act (HIPAA).
  • Responsible for completion of other tasks or duties that are assigned.

Qualifications Required:

Education and Experience:

1. Associate’s Degree in Business and two years of experience in a medical office, telemarketing, retail or customer service is preferred. An individual with an equivalent combination of education and work experience may be considered.
2. Experience with Word, Excel, Brightree, is strongly suggested.

Knowledge and Skills:

1. Strong communication, teamwork and organizational skills.
2. Excellent written and verbal skills.
3. Flexible, with ability to adapt to a fast paced, rapidly changing circumstances.
4. Must have ability to maintain a positive attitude, especially during high stress.
5. Must be detail oriented, with strong analytical ability.

Span of Control:

This position is responsible for SCA submissions, contract negotiations, denial reviews and entry of Insurance data into the PRC financial database for all types of insurance, including MCOs and any required Medicaid changes for the entire United States. Responsible for relaying related information to appropriate team members via emails, meetings and providing any necessary training to ensure full compliance. The Contract Specialist may negotiate discounted rates with the approval of Management and adheres to many regulations established corporately and/or federally.

Communication:

Extensive contact. This position handles calls each day from a wide range of customers. They may need to influence, calm, diffuse, and persuade a customer through their conversation. Must be an expert listener, maintain customer confidentiality and have negotiating skills.

If you are interested in applying for this  position, please send your resume, professional references and salary requirements to humanresources@prentrom.com.