Hybrid Contract Operations Specialist

at Advocate Aurora Health

• Job title: Contract Operations Specialist
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $28 - $42 per hour
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Milwaukee, United States

About the role

• Analyzes Managed Care reimbursements and ensures compliance with payment terms at Advocate Health. Works collaboratively to identify and resolve payment discrepancies in a healthcare environment.

Responsibilities

• Analyzes and audits Managed Care reimbursements of designated contracts to ensure payor's compliance with payment terms.
• Utilizes third party software to identify and pursue payment discrepancies.
• Monitors claims payment experience to identify revenue opportunities.
• Documents and reports ongoing payment/rate compliance with financial contractual obligations.
• Analyzes trends in data to develop excel spreadsheets for payment anomalies.
• Submits payment recoveries to payers or regulatory agencies for determinations and resolution.
• Identifies discrepancies and contract compliance issues and resolves the problems working in conjunction with payers, providers, and Aurora departments.
• Serves as a liaison, and effectively communicates with providers, physicians, payors, consultants, agents, and Aurora departments.
• Ensures that all parties are meeting contractual obligations with respect to operation activities and facilitates positive relations, problem solving and service improvements.
• Develops and publishes all communication on assigned contracts, system wide email communications, reference tools, product and rate summaries, prior authorization requirements and other contract operational documents.
• Monitors contract change dates, necessary amendments obtain and validate rate increases, fee schedules, and reimbursement methodologies.
• Works in partnership with management to improve contract claim processing through identified errors and process improvement activities, recommend potential contractual amendments.
• Monitors and identifies training needs with in patient financial services and patient registration.
• Effectively educates and trains staff on managed care principles, contract requirements and administration procedures (referrals, pre-authorizations, etc.) to maximize revenue.
• Identifies and suggests operational process improvement initiatives that may result in further meeting contractual obligations.
• Acts as the key resource for internal customers throughout the Aurora Health Care system; business office, revenue cycle, clinics, hospitals, ancillaries, medical management on all contract aspects and compliance questions.

Requirements

• Bachelor's Degree in Health Care Administration or related field
• Typically requires 3 years of experience in managed care contracting, or insurance networks within a health care environment
• Strong working knowledge of managed care contracting, contracting language, insurance networks, and reimbursement methodologies.
• 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.

Benefits

• 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
• 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