Humera - Administrative and Professional Staffing

Provider Contract Analyst

Location
Minneapolis, MN, United States
Salary
Contact For Rate
Posted
Feb 19, 2018
Closes
Feb 21, 2018
Job Type
Employee
Employment Status
Full Time
Humera has positions available for Provider Contract Analyst with our client in NE Minneapolis, a company providing health coverage and services to members in Minnesota and western Wisconsin.
This is a long term contract position!

Duties:
  • Setup and update Standard & Non-Standard Contracts in PRC databases, including contracted entity and site location changes. Generate unilateral amendments to the contract, audit database set up and compare contractual obligations as listed in the provider contract document.
  • Use Amisys and Cactus to ensure entities and site locations are correct and accurate.
  • Use Medicaid verification and OIG Exclusion verification systems prior to set up of new entities or ownership changes to ensure that they do not have any sanctions against them.
  • Use National Plan & Provider Enumeration system prior to setup to ensure NPI?s are valid.
  • Participate with internal and external committees and PRC database user groups in collaboration with manager. Keep manager informed of changes that will impact our client. Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner
  • Participate in and maintain long term projects to increase the efficiency and accuracy of the data in PRC databases.
  • Assist with the completion of large scale contracted entity and site level updates as needed.
  • Daily external provider contact via emails and phone calls.
  • Daily internal customer issues and concerns via service forms, emails and phone calls.
  • Ensure department turnaround time guidelines are met and accurate.
  • Other projects and duties as assigned.

Requirements:
Education
  • Two year degree or equivalent in computer systems & technology preferred; demonstrated experience may be considered in lieu of degree.
Required Experience
  • Two or more years of experience in a managed health care environment.
  • Must possess working knowledge of managed care operations.
  • Advanced PC experience.
  • med
Preferred Experience
  • Experience as a Systems or Business Analyst.
  • Knowledge of Amisys, Maccess, Cactus, SharePoint, and Microsoft Office software
  • System knowledge of Medicaid Verification, OIG exclusion, National Plan & Provider Numerations.

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