[Hiring] Contract System Management Analyst @Option Care Health

Role Description

Responsible for preparing third party payer agreements to load in the pharmacy management system for Option Care. Responsible for building the third party payer agreements in the pharmacy operations system (CPR Plus). Research, understand, and interpret the applicable billing rules, billing units, and terms and conditions of the agreement in order to drive success in billing and collecting on the services provided by Option Care. Supports the Managers and Directors within the Commercial Contracting group facilitating a cross functional and collaborative working relationship with Contracting, Pricing, Trade, and Revenue Cycle Management. Collaborate closely with the Contract Operations Department, as well as Revenue Cycle Management and the CMCs.

Job Responsibilities

• Create and build the record for third party payer contract agreements, including creating insurance plans, researching and inputting business rules, and loading the contract pricing terms for implementation.
• Maintain assigned payer agreements, updating and executing any changes to pricing, coding, or business rules.
• Work with the Contracting and Revenue Cycle Management on site integration to ensure proper insurance plans are accounted for and assigned to the correct location.
• Identify contracts that are not generating revenue to see if there is an opportunity to purge records and reduce insurance plan selection errors.
• Audit third party agreement pricing tables to ensure accuracy to improve Revenue Cycle Management success.
• Collaborate with Pricing team when trends are identified to ensure proper insurance plan was utilized to maximize profitability by reducing bad debt and other payer adjustments.
• Collaborate with IT and Revenue Cycle Management on System Upgrades that could impact contract build, as well as make recommendations on system enhancement opportunities.
• Collaborate with Revenue Cycle Management to ensure proper insurance plans are set up and able to be utilized by CMC.
• Provide detailed advanced system reports for revenue cycle management and pricing teams as it relates to payer pricing strategies that are being input into the system.
• Assist with training of Contract System Management Specialists.

Supervisory Responsibilities

No supervisory responsibilities.

Qualifications

• Bachelor’s degree, or High School Diploma with at least 5 years of experience in Revenue Cycle Management, Contract Management, Home Infusion intake, or home infusion pharmacy technician.

Requirements

• Ability to work in a deadline driven environment.
• Strong analytical and problem solving skills.
• Ability to function individually as well as in cross-functional teams.
• Ability to identify improvement and growth opportunities.
• Advanced level skill in Microsoft Excel with the ability to do VLOOKUP, basic formulas, and pivot table work.
• Experience with analyzing and reporting data to identify issues, model trends, or exceptions to drive improvement of results and find solutions.
• Experience with HCPCS coding, and Drug Pricing Sources (AWP, ASP, WAC).
• Intermediate level skill in Microsoft PowerPoint and Microsoft Word.
• Willing to travel up to 10% of the time for business purposes (within state and out of state).

Preferred Qualifications & Interests (PQIs)

• CPR Plus experience.
• Contract Management experience.
• Experience with Medicare, Medicaid, PBM, and other third party payer payment guidelines.

Benefits

• Medical, Dental, & Vision Insurance.
• Paid Time off.
• Bonding Time Off.
• 401K Retirement Savings Plan with Company Match.
• HSA Company Match.
• Flexible Spending Accounts.
• Tuition Reimbursement.
• myFlexPay.
• Family Support.
• Mental Health Services.
• Company Paid Life Insurance.
• Award/Recognition Programs.