Contract Operations Specialist Senior

Department:

Status:

Benefits Eligible:

Hours Per Week:

Schedule Details/Additional Information:

• Remote position, with occasional on-site presence as needed at our academic medical centers.
• Day schedule, Monday - Friday.

Pay Range:

Job Description:

Designs and leads the implementation of managed care contract requirements within Aurora Health Care. Develops and maintains strong business relationships with health insurance organizations while providing a single point of contact for Aurora Health Care revenue cycle business operations. Interacts with all aspects of the revenue cycle operations and insurance carriers to track, trend and resolve payer related issues. Performs root cause analysis and acts as the reimbursement subject matter expert for managed care agreements. Ensures physician, hospital and ancillary claims are paid according to contract agreements.

Major Responsibilities:

• Serves as the key contact for the managed care operations department and effectively communicates with providers, physicians, payers, consultants, agents, and Aurora revenue cycle departments. Ensures that all parties are meeting contractual obligations with respect to operation activities and facilitates positive relationships, problem solving and service improvement recommendations. Provides leadership with trends, feedback and recommendations on closing contract language gaps & opportunities for improving contract performance.
• Builds, updates and ensures the accuracy of the department contract database. Utilizes database to develop detailed standard and ad-hoc reports used to analyze underpayment and overpayment issues and to support department projects and initiatives.
• Designs, implements and maintains all aspects of the managed care operations website including product summaries, revenue reimbursement rates, and content accuracy. Responsible for user ability testing and overall site maintenance. Ensures appropriate messaging is applied.
• Leads and guides team members in project management and contract research projects. Defines project plans and goals, performs impact analysis, provides status reports and keeps management apprised to ensure project plans and deliverables are being met.
• Develops and publishes monthly managed care operations department newsletter. Gathers newsletter content, focus topics on relevance, develops and formats newsletter, establishes and test links and documents, adds\deletes users DL mailing, follows up and research questions, clarification.
• Facilitates meetings with insurance companies and internal business partners to address issues impacting the business relationship such as payment issues and workflow discrepancies. Works closely with insurance companies to identify process improvement opportunities.
• Accountable for oversight and support of third party software. Monitors software performance and coordinates administrative updates to auditing software, validates appropriate calculations ad rates are accurate.
• Participates in and serves as a subject matter expert in recommending workflow changes to support revenue cycle business needs. Reviews untouched variance opportunities and makes process improvement changes that contribute to more effectively managing the volume and timely review of contracts.
• Acts as a gatekeeper for the Aurora payer dashboard, providing enhancement recommendations, training and access to internal and external stakeholders. Assesses and interprets internal and external partner’s needs, provides guidance and support to meet the requirements.
• Monitors productivity and financial recoveries at the individual and team level to ensure department goals are achieved. Responsible for cross training functional teams. Works closely with the leader to perform quality checks, coach and provide feedback by guiding staff and acting as a resource.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• Bachelor's Degree in Health Care Administration or related field.

Experience Required:

• Typically requires 5 years of experience in managed care contracting, or insurance networks within a health care environment.

Knowledge, Skills & Abilities Required:

• Strong working knowledge of managed care contracting, contracting language, insurance networks, and reimbursement methodologies.
• Demonstrated knowledge and understanding of medical terminology, abbreviations, medical codes (CPT, ICD and HCPCS coding), coding conventions and rules established by the AMA, CMS and insurance payment policies.
• Knowledge of various types of medical claims and payment types, claim policies and procedures and provider contract guidelines.
• Intermediate level proficiency in the use of Microsoft Office (Excel, Word and Access) or similar products.
• Excellent analytical, organizational, and problem solving skills.
• Must have excellent verbal and written communication skills to effectively work with payers. Ability to articulate complex claims issues and interacts with various levels within the organization to obtain desired results.
• Strong time management and organizational skills and ability to pay close attention to detail.
• Ability to work independently and with minimal supervision.

Physical Requirements and Working Conditions:

• Must operate all equipment essentials in performing the job.
• This position may require some travel so will be exposed to weather and road conditions.
• Generally exposed to a normal office environment.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health 

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.