Claims ResolutionPrimary Location: Richmond, VA
Additional Locations: VA-Richmond Apply
- Responsible for reviewing, building, loading, and auditing complex contracts, agreements, amendments and/or fee schedules in contract management systems.
- Conducts research, analysis and/or audits to identify issues and propose solutions to protect data, contract integrity and performance.
- Provides technical expertise for questions related to contracting and related systems and information contained.
- Partner across the organization to support network development, maintenance, refinement activities, regulatory filings, migration and rate activities.
- May coordinate complex contracting activities, implementation, coordinate receipt and processing of contracts and documentation and pre-and post-signature review of contracts and language modification.
- Collaborates on negotiations or may handle contracting and re-contracting discussions with solo providers or small groups.
- May conduct or assist with service activities such as provider education, technology usage, or process updates.
- May recruit providers in support of network management and expansion initiative or analyze market data for outreach mailings to desired expansion targets
- 5 years related experience.Knowledge of basic negotiating skills desired.Proven working knowledge of standard provider contracts, terms and language desired.
- Strong communication, critical thinking, problem resolution and interpersonal skills.
- Bachelor’s Degree or equivalent combination of education and experience.
- Serve as main point of contact for large health systems in Virginia, to assist in claims research and resolution.
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