Job Description :
Position: Provider Contract Analyst Duration: 4 months Job location: Downtown Dayton, OH Process: Local candidates/phone/in-person and open to Skype/WebEx About ALTA IT Services It is a leading IT staffing firm that empowers people and companies to thrive. We specialize in finding, retaining, and developing top IT talent for our clients. It has helped business leaders add value, drive growth, and achieve competitive advantage in the marketplace. Learn more at Summary of Opportunity It has an immediate need for (2) Provider Contract Analysts for a 4-month contract with our client in downtown Dayton. This individual will provide subject matter expertise for technical guidance, training and direction with a team of development professionals. Nature of work: Business Need: Build out a data structure to allow for agreement ID lookup by tax ID. Goals: Eliminate the need for PIM specialists to review contracts in order to determine reimbursement rates Reduce top PIM error impacting claims reprocessing Reduce time for provider load Improve accuracy of provider payments Work Needed: existing contracts to determine reimbursement rates Align rates with appropriate agreement IDs Build out data structure to store agreement ID by TIN, market, and LOB Include date parameters for agreement IDs Allow data structure to be searched by users Validate information against current Facets data once completed Success Measures: List of participating tax IDs to indicate agreement IDs by line of business and effective dates Defined process for ongoing additions to this list based on new contracts/amendments Skillsets: Contract interpretation Choreo/Contract Manager experience is a plus Facets knowledge Data manipulation in Excel Research and analysis Job Responsibilities: Ensures operational effectiveness by assisting in strategic and business planning, including business, financial, and operational goals and objectives Provide oversight to all new contracts to ensure that appropriate and timely claims system set up occurs and that rigorous testing yields appropriate outcome prior to payment methodology implementation Identify issues related to reimbursement and recommends appropriate solutions. Includes generating and analyzing queries or reports for analysis Analyze provider database to ensure data consistency and optimal database structure Takes a leading role in the review of reports and data for pattern identification, special cause variation identification, trend analysis, or other techniques; prepare and deliver summaries, recommendations, or alternatives of the analyzed information Serves as provider data representative in claims editing decisions and implementation and oversight of testing to ensure that it yields appropriate claims processing Assist in servicing key hospital or other designated providers in all lines of business, existing and future to ensure rapid diagnosis and resolution of complex claims issues Build and strengthen provider relationships by facilitating quality service Actively participate in operational calls with key providers or network partners as needed Proactively communicates technical system changes, claims processing, CareSource policies on reimbursement, take-back initiatives, and configuration Ensure all governing body regulations are adhered to at all times for existing and future lines of business Mentor internal resources to achieve cross-functional capability with project execution and subject matter expertise Thanks and Regards, Shivangi Singh | Team Lead | KPG99, INC Certified Minority Business Enterprise (MBE) Direct| |