Provider Contracting Senior Analyst
U.S. healthcare today is confusing, inefficient and expensive. Maestro Health is on a mission to change that by making health and benefits people-friendly again.
Our team of Maestronites (yep, that’s what we call ourselves) is revolutionizing not only the way we view health and benefits but also the way we shop, enroll and live with our benefits using a tech-meets-service approach. We’re a team that takes our work (but not ourselves) seriously.
WHAT YOU WILL BE DOING:
Maestro Health is looking for a Provider Contracting Senior Analyst to be a key team player within Repricing Insights Team that is responsible for facilitating healthcare reimbursement contracts, loading the contract terms between payers and providers into our systems in an accurate and timely manner using proprietary software. This position requires an in-depth knowledge of healthcare reimbursement processes and procedures including institutional, as well as professional payment systems.
The Provider Contracting Senior Analyst position reports VP Service Operations and will collaborate with the programming and development teams in the creation and vetting of calculation methods, database loads, and desired system changes. Further, this position is an internal resource to staff and clients and will need to respond to both internal and external issues in an accurate and timely fashion.
- Interacting with clients to determine and document requirements, researching and deciphering contractual language regarding commercial payment arrangements
- Drafting concise documentation for payment procedures—including payment calculation logic—and interacting with the development team to refine that documentation into user stories and project plans
- Performing data analysis tasks (i.e. fee schedules, provider files, base rates) using in-house or off-the-shelf software (such as Microsoft Excel)
- Maintains contract grid for clients
- Load contracts negotiated between payers and providers
- As needed claims repricing and EDI files transfers
- Assisting with quality assurance activities, compliance audits, troubleshooting, and defect correction
- Educating internal and client staff regarding payment procedures
- Participates in client implementation planning, conference calls, meetings, and trainings
- Staying current on application functions, features, and industry trends. Demo the product as part of the sales process.
- Guide response to technical issues by creating solutions that are technically and financially feasible that meet business needs. Work with all parties involved to develop and deploy agreed upon solutions. Provide the data necessary to make educated decisions.
- Other duties as assigned
WHAT SUCCESS LOOKS LIKE
- Zero error rate will be a key indicator of success
- Adherence to established policies and procedures for internal compliance and control standards
- Meeting internal and/or contractual deadlines.
- Use of data to drive changes to Repricing Insights that increase client satisfaction, provider usage and internal cost reduction
- Adhere to our core values: Courage, Customer First, Integrity and One Maestro,
WHAT YOU NEED
- Bachelor’s Degree and/or equivalent work experience in Healthcare Revenue Cycle Management/Contracting field, Cost Containment, Claims Repricing and Audits
- Two to Five years cost containment, claims repricing, and contracting experience in health insurance
- Certified Professional Coder
- Background in ROI/profit and loss
- Strong analytical and detail-oriented skills
- Excellent communication and organizational skills
- Ability to manage time effectively, set priorities and meet deadlines
- Desire/ability to work successfully in a small, entrepreneurial company environment
- Self-directed individual who works well with minimal supervision
- Demonstrated critical thinking skills
WHY WORK AT MAESTRO HEALTH?
We’ve recently teamed up with AXA and we’re growing fast. Really fast. So, we’re looking for hard-working, talented, passionate and like-minded people who want to join us on our mission. Your work will be critical in our success as we continue to grow and make an impact in the healthcare industry.
We have great benefits, along with a fun, energetic and fast-paced environment.
- Personal, Vacation and Sick Time
- Medical and Prescription
- Life and Disability
- Health and Wellness programs
- 401k with Employee Match
- Figo – Pet Insurance
Are you ready to become a Maestronite? Let’s do this.
Maestro Health is an equal opportunity workplace. We are committed to equal opportunity regardless of race, color, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, or veteran status.