• Job Description

  Req#: R-24110

  Work Location

  Orange, California

  
  Work Shift

  Day – 08hrs (United States of America)

  Why CHOC?

  At CHOC, we strive to be the leading destination of children’s health by providing exceptional and innovative care. We are responsible for the overall health of our community’s pediatric population in our hospitals, clinics, and practices. And because of our breadth of care, your career at CHOC can be as diverse and fulfilling as you determine. CHOC’s compensation structure, benefits offerings, and career development programs are geared to helping you achieve your professional and personal goals. Apply now to see where your career at CHOC can take you.

  Job Summary

  The Managed Care Contracts Analyst is responsible for defining and updating Hospital and Professional Contracts and maintaining physician and hospital profiles and payor codes in the payor contract management platform. Requires experience and knowledge to proficiently interpret, review, validate, and load new and existing Managed Care, health plan and other payor contracts via the platform and update contract profiles. Extensive understanding of reimbursement methodologies to include capitation and FFS with the ability to initiate implementation of the payor profile, answer support questions from the vendor in a timely manner and ensure consistency between the contract profile, definitions, and the payor agreement. Respond to issues in conjunction with the Revenue Cycle/Business Office team related to payment of claims. Provides input to inform contracting activities including contract negotiation, modeling, payor performance/payor relationship. Researches and reconciles contract-related questions, payment problems, irregularities, billing errors and disputes. Responsible for effectively utilizing and navigating the contracting system to monitor, maintain, and ensure integrity of data.

  Pay Range

  Minimum $64,958 Midpoint $86,070 Maximum $107,162

  Rate of pay is determined by various factors, including but not limited to knowledge, skills, competencies, experience, education, as well as position requirements.

  Experience

  • Required: Minimum three (3) years of experience with a contract management platform such as Nthrive, Experian or equivalent.

  • Preferred: Medical group , IPA or integrated health system experience

  Education

  • Required: Bachelor’s degree in Heath Care Administration or equivalent experience may be accepted in lieu of education.

  Training

  • Required: N/A

  Specialized Skills

  • Required: Demonstrated experience in interpreting facility and professional payor contracts, understanding reimbursement methodologies and billing and payment processes.

  Experience with Medicare, Medi-Cal, Commercial HMO and PPO/EPO/POS claims adjudication methods for physician as well as inpatient and outpatient hospital claims. Demonstrated knowledge of coding conventions and the function of CPT codes and HCPCs Codes, DRG codes, Revenue Codes, Occurrence Codes, ICD-10 Diagnosis, and ICD-10 Procedure Codes. Knowledge of various payors including Medicare, Medicare Advantage Plans, Commercial PPO/EPO/POS Plans, Medicaid/Medi-Cal and Medicaid, Medi-Cal/Managed Care Plans. Experience in claims scrubbing and application of edits for Medicare, Medicaid, medical and commercial payors for both hospital and professional services. Demonstrate healthcare reimbursement knowledge by obtaining satisfactory result on sample reimbursement questions. Demonstrates the ability to work with minimal guidance and as part of a team, interacting both internally and externally with all levels of management and associates. Demonstrates experience and knowledge of principles and practices used in the development of contracts, contract administration, and negotiation strategies. Able to: interpret and apply organizational and department policies and procedures; prioritize and meet required deadlines; accept and participate in change. Advanced ability to use Microsoft Office Suite (Word, PowerPoint, Excel, Outlook) with emphasis in Excel, and expert knowledge utilizing the contract management platform. Highly proficient in time management, organization, planning, and prioritizing. Excellent interpersonal, communication, writing, and analytical/issue resolution skills.

  Licensure

  • Required: N/A

  Work Environments - Functional Demand:

  Sedentary - Very light energy level Lift 10 lbs. box overhead. Lift and carry 15 lbs. Push/pull 20 lbs. cart.

  Physical Activity Requirements:

  Bending, Carry Objects, Climbing, Keyboard use/repetitive motion, Pinching/fine motor activities, Push/Pull, Reaching forward, Reaching overhead, Sitting, Squat/kneel/crawl (Squad & Knee), Standing, Talk or hear, Taste or smell, Twisting, Walking, Wrist position deviation

  Physical Activity Lifting

  Lifting (Floor to waist level) - Occasional 0-35%, Lifting (Waist level and above) - Occasional 0-35%

  Sensory Requirements:

  Color Discrimination, Depth Perception, Far Vision, Hearing, Near Vision

  Environment Requirements:

  Airborn Communicable Disease, Bloodborne Pathogens, Chemical, Dust Particular Matter, Extreme Noise Levels, Extreme Temperatures, Radiation, Uneven Surfaces or Elevations

  Non-Discrimination Statement:

  CHOC does not discriminate on the basis of age, race, color, religion, national origin, ancestry, marital status, genetic information, disability, sex, gender (including pregnancy, breastfeeding, childbirth, lactation or related medical conditions), gender identity or expression, medical condition, sexual orientation, veteran status, military or uniformed service member status, or other protected characteristics in accordance with state and federal laws.

  We encourage individuals from all backgrounds to apply for positions at CHOC, even if your experience doesn’t align perfectly with the listed qualifications for a particular role, as your unique experience may be a great addition to our culture for another one of our opportunities.

  If you desire support or accommodations throughout the Talent Acquisition process, please inform your Talent Acquisition Partner.

• About the company

  Children's Hospital of Orange County, also known by its acronym CHOC or Children's Hospital OC and branded as CHOC Children's, is a pediatric acute care hospital located in Orange, California.

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