[Hiring] Contract Resolution Specialist @CoxHealth

Role Description

The Contract Resolution Specialist primary function will be to assist network providers with any contractual issues. The Contract Resolution Specialist will also act as a trainer/educator of all CoxHealth Network contracts to the network providers and their staff. They must be a self-starter and work with minimal supervision. Some local travel is required along with organizing and hosting meetings when required.

• Possess an in-depth working knowledge of managed care plans and CoxHealth contracts.
• Understand the legality of the messenger process CoxHealth Network uses for independent providers.
• Analyze and communicate contractual terms and their requirements to the provider.
• Perform initial and recredentialing on-site reviews and chart audits for providers, as needed.
• Responsibilities include, but are not limited to:
• Contract resolution.
• Delivery and interpretation of policy and procedure changes as it relates to specific contracts.
• Communication of regulatory changes as it relates to the insurance industry as needed.
• Researching new technology with respect to payors medical necessity and coverage.
• Maintaining contacts and providing educational information to network, tertiary/affiliate PHO networks that impact over 3000 providers/facilities.
• Organizing, prioritizing, and multi-tasking to execute projects and day-to-day workflow.

Qualifications

• Required: High School Diploma or Equivalent
• Preferred: Bachelors in a Related Field

Requirements

• Required: 3-5 Years experience working in the provider office, healthcare billing, healthcare insurance and/or Managed Care industry.
• Preferred: Previous experience in provider relations and/or physicians office management.

Skills

• Ability to understand complex multi-provider payor contract agreements and determine compliance standards are being adhered to.

Benefits

• Medical, Vision, Dental, Retirement with Employer Match and more (20+ hrs/week)