Contract System Management Analyst - Remote

Summary

Option Care Health is a home and alternate site infusion services provider. The Contract System Management Analyst prepares, builds, maintains, and audits third-party payer agreements in the pharmacy management system, ensuring accurate billing rules, pricing, coding, and insurance plan setup. The role also collaborates with Contracting, Pricing, IT, and Revenue Cycle Management teams and assists with training specialists.

Responsibilities

• Create and build the record for third party payer contract agreements. This includes creating insurance plans, researching and inputting business rules, and loading the contract pricing terms for implementation
• Maintain assigned payer agreements. Update and execute any changes to pricing, coding, or business rules
• Responsible for working with the Contracting and Revenue Cycle Management on site integration to insure 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 insure proper insurance plan was utilized so that we are maximizing 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 insure 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

Skills

• 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
• 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 an ability to do VLOOKUP up, basic formulas, and pivot table work
• Experience with analyzing and reporting data ability 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
• CPR Plus experience
• Contract Management experience
• Experience with Medicare, Medicaid, PBM, and other third party payer payment guidelines

Qualifications

Must Haves

• 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
• 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 an ability to do VLOOKUP up, basic formulas, and pivot table work
• Experience with analyzing and reporting data ability 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

Nice to Haves

• 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