Payer Contract Specialist

Position Description:

The Contract Specialist will report to the VP, Revenue Operations.  As a member of the Revenue team, your primary role will be the subject matter expert on contract content and performance.  This starts with the ability to ingest complex contract terms, and distill them down to key points for purposes of education and operational implementation.  The ability to analyze and report on reimbursement trends at the contract level for purposes of optimizing contract performance is a priority.  You will work closely with the Payer Projects team to identify rejection issues and bottlenecks in claim processing, and use ongoing feedback and data analysis to help inform the Payer Contracting team regarding opportunities for future contracts.  

Flexibility and a willingness to perform varying tasks to support the team and organization are a must.

Responsibilities:

• Ingest, summarize, and operationalize content of contracts.
• Act as point person for new contract implementation.
• Analyze reimbursement data to support understanding of performance and profitability of contracts. 
• Monitor payment trends to identify underpayments; work with payer contacts to obtain corrected payment.
• Assist Claims and Denial Specialists with issue resolution by clarifying contract terms or escalating issues with payer contacts.
• Assist Revenue leadership with identifying and implementing tools to provide better transparency of in-network status at payer and plan level.
• Manage payer fee schedules.
• Partner with Payer Knowledge Specialist to identify new reimbursement opportunities.

Qualifications

• Bachelor’s degree in Healthcare Administration, Finance, or equivalent experience.
• Have a minimum of 3 years experience in medical group contracting and reimbursement analysis.
• Have prior experience working in a behavioral health setting preferred.
• Love to do research, and are a naturally curious person.
• Have strong written and verbal communication skills.
• Can share examples of owning/overseeing cross functional projects.
• Are a creative problem solver.
• Enjoy working in collaborative environments.
• Have solid experience with Excel (required), G Suite, Business Intelligence platforms (Mode, Tableau, etc), project management software, Practice Management systems (athenahealth preferred).
• Possess working knowledge of a wide range of contract types (Fee for Service, Bundled Payments, Capitation/PMPM).
• Want to be a part of a mission driven company making a difference in the lives of the members we serve, and will serve in future.

About Eleanor Health

Eleanor Health is the first outpatient addiction and mental health provider delivering convenient and comprehensive care through a value-based payment structure. Committed to health and wellbeing without judgment, Eleanor Health is focused on delivering whole-person, comprehensive care to transform the quality, delivery, and accessibility of care for people affected by addiction.

To date, Eleanor Health operates multiple clinics and a fully virtual model statewide across Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, Texas, and Washington, delivering care through population and value-based partnerships with national and regional payors, employers, and other stakeholders.

If you are passionate about providing high quality, evidence based care for individuals with substance use disorder through an innovative practice, and about building a great business that makes a difference, Eleanor Health is an ideal opportunity for you. We seek highly skilled, motivated and compassionate individuals who take responsibility and adapt quickly to change to join our deeply committed and collaborative team.

Job Type: Full-time