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Healthcare Contract Specialist

The Healthcare Contract Specialist will be responsible for providing analytical and technical services in the areas of hospital price transparency, managed care and governmental reimbursement, and various financial analysis. This role will demonstrate strong Excel and organizational skills with a familiarity of chargemaster pricing and related net revenue impact related to contract terms. This position requires an understanding of hospital managed care contract terms and rates sufficient to interpret, direct and input or load into consulting software or managed care contracting database for purposes of developing hospital machine-readable files for price transparency.

Responsibilities

  • Provide hospital payer contract expertise to the Financial Services team to support clients with Hospital Price Transparency requirements
  • Analyze and interpret complex language from payer contracts to understand managed care terms and rates.
  • Learn and utilize contracting management systems to accurately input payment rate data and term information.
  • Conduct quality reviews to ensure accuracy and completeness of all contract data.
  • Support updates to CMS rates, fees, and financial indexes for reimbursement calculations.
  • Attend internal meetings to provide status updates and collaborate with team members and clients proactively.

Qualifications

  • Must have healthcare experience with hospital payer contractual terms and rates.
  • In-depth understanding of hospital managed care contract terms and rates sufficient to interpret, direct and input or load into consulting software or managed care contracting database
  • Strong proficiency in using Microsoft Office such as Word, Outlook, and Excel including the ability to utilize advanced functions.
  • Proven ability to work independently and efficiently manage workload, with a track record of meeting deadlines and delivering high-quality work.
  • Meticulous attention to detail with a commitment to accuracy, particularly in data entry and contract analysis.
  • Clear and coherent in both verbal and written communication skills, with the ability to clearly articulate complex concepts and explain the impact of payer rates and terms on reimbursement for various healthcare services.
  • Strong analytical skills with the ability to interpret and analyze complex contract language, financial data, and reimbursement methodologies.
  • Ability to work collaboratively within a team environment, attending internal meetings, providing status updates, and contributing innovative ideas to problem-solving initiatives.

Screening Criteria

  • Bachelor’s degree or equivalent combination of education and related work experience.
  • Minimum of two (2) years of experience in hospital managed care or experience with hospital reimbursement, payer contracting, and/or managed care modeling of rates and terms
  • Must have a stable employment history.
Job Category: Healthcare
Job Location: WFH Permanent

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