Job Description

DESCRIPTION: PAYER OPERATIONS ANALYST 35495

EDUCATION REQUIRED: BA YEARS' EXPERIENCE REQUIRED: 3-5 yrs TOP NEEDS:

1. Previous work experience in the healthcare industry (may be included but not limited to billing, claim processing, collections, DME processing, or contacting experience
2. Understanding of healthcare industry systems and the operational / financial transactions between provider and Health Insurance Payer
3. Licensing, Credentialing and Accreditation experience for medical device manufactures DESCRIPTION:

• The Payer Operations Analyst role will support the Managed Markets team within Strategic Channels.
• The Payer Operations Analyst will serve as a key partner to Health Plan Solutions, Inside Sales, Strategic Channels, Legal and Compliance by ensuring adherence to Commercial and Government policy guidelines.
• Key responsibilities include researching, documenting and communicating health plan policy requirements, facilitating external health plan compliance audits, providing feedback and facilitating implementation of solutions to root cause health plan claims reimbursement issues, and support the contract review process by reviewing and drafting contract documents to assist in the mitigation of legal and operational business risks to the organization through contract lifecycle management of health plan / provider contract agreements.

RESPONSIBILITIES MAY INCLUDE THE FOLLOWING AND OTHER DUTIES MAY BE ASSIGNED:

• Health Insurance Payer website research and fee schedule look-up.
• Research, document and maintain Health Insurance Payer requirements.
• Research and assist in resolution with issues related to Health Insurance Payment Discrepancies, Licensing, Credentialing. Gather and analyze data for Health Insurance Payer audits.
• Administers, extends, negotiates, and terminates standard and nonstandard contracts.
• Conducts proposal preparation, contract negotiation, contract administration, and customer contact activities to provide for proper contract acquisition and fulfillment in accordance with company policies, legal requirements, and customer specifications.
• Prepares bids, processes specifications, progress, and other reports; advises management of contractual rights and obligations; compiles and analyzes data and maintains historical information.

SPECIALIST CAREER STREAM:

• Previous work experience in the healthcare industry (may be included but not limited to billing, claim processing, collections, DME processing, or contacting experience).
• Understanding of healthcare industry systems and the operational / financial transactions between provider and Health Insurance Payer.

Company Description

As a leading contract, contract-to-hire and professional placement firm, Three Point Solution understands the importance of aligning our client with the right resource at the right time. We are committed to the highest caliber of service that will benefit our clients, candidates and employees. Unlike large, corporate style recruiting firms, we commit to individualized attention that uniquely positions us to bridge the communication gap between recruiter, employer and candidate. Our goal is to cultivate and maintain true partnerships with our clients and candidates.