• Analyzes the Contract Terms and Conditions in a timely manner and makes recommendations for new contract loads, formulates and implements amendments and changes, and rollover contracts as part of the client audit, deviating from established procedures as necessary.
• Regularly exercises discretion in analyzing and identifying issues associated with reprice impact reports after communication log issue have been corrected and re-priced. Formulates and implements solutions to identified issues and is empowered to make exceptions when required to move issues to resolution.
• Independently audits and verifies post-contract changes.
• Collaborates with Client Managed Care and Med Assets Account Rep to ensure contract profiles are pricing accurately, per contract language.
• Reviews internal requests for assistance and executes work list/queries for newly opened communication logs. Documents affected accounts as required.
• Identifies alternative opportunities in contract interpretation and revenue routing through the analysis of issues and, acting as a subject matter expert, provides alternative recommendations to management and staff. Activation of plan ID�s in mainframe system and MedAssets complying with NIC standards. Request approvals from Managed Care for NCCI edits if stated in contract and forward to the appropriate parties for loading.
• Communicates with appropriate leadership to ensure discrepancies are resolved prior to close of month end.

KNOWLEDGE, SKILLS, ABILITIES

• This position requires knowledge of and the ability to perform all functions of the Contract Analyst.
• Advanced understanding of hospital billing form requirements (UB-04)
• Advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology
• Advanced Microsoft Office (Word, Excel)
• Advanced knowledge of query writing applications a plus
• Advanced managed care/government contract interpretation skills
• Strong analytical abilities

EDUCATION / EXPERIENCE

• Minimum 1 year contract interpretation experience required
• Bachelor or Associate Degree preferred
• 3-5 years of relevant hospital business office experience preferred
• Must be able to implement a systematic, self motivated approach to problem solving and be able to identify, coordinate and optimize resources needed to execute plans

PHYSICAL DEMANDS

• Must be able to work in sitting position, use computer and answer telephone
• Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
• Ability to lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision.
• Ability to travel

• Office Work Environment
• Hospital Work Environment

• Other duties as assigned

Employment practices will not be influenced or affected by an applicant�s or employee�s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.