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Years of Experience
Date Last Verified
ProfileContract Specialist II Responsibilities: Responsible for the Quality Review (QA) of all Contracts loads and updates. Conducts and leads monthly team meetings to review top account issues, denials, adjustments and held item errors and recommends quarterly review topics to the managed care team. Communicates with the Billing Center, Central Intake, Sleep Central and Locations regarding contract changes and/or updates including distribution of reference guides as required. Conducts/leads implementation calls regarding payer rule changes and/or updates with billing centers. Maintenance and administration of all Contracts Rotech provides service for including but not limited to Managed Care, Government, Hospice, Skilled Nursing, Non-Participating or Out of Network, Professional Service Agreements and Patient Pay Contracts. Administration of contracts includes but not limited to a complete redline/review of payer contract language, policies and procedures, provider manuals, billing rules and guidelines. Participates and assists with the research and preparation of Request for Proposals (RFP) and solicitations as required. Development of Quick Reference Guides (QRG’s) Hospice, Non-par and specified Managed Care Contracts including the development and maintenance of Government reference guides as required. Research and analysis of department assigned adjustments and development of monthly trend and root cause reports. Conducts Contact implementations with appropriate departments as well as payer in-services as required. Review and analysis of Contract Quick Reference Guides submitted by the Managed Care Organization and interpreting payer rules and guidelines for appropriate set up in Contract and Item Master. Analysis includes, a quality review Contract Plan type and Class for accurate revenue tracking, payer rules to include prior authorizations, cap rental rules and appropriate document requirements which all contribute to held item and adjustments. Monitors the release of solicitations daily and maintains a list of active solicitations within company database. Maintains database of contracts within shared drive, e-Intake and Contract Logix. Creates FOIA requests as appropriate. Files yearly government reports such as Subcontracting report, CCR registration, Vets-100. Research of competitor information. Conducts conference calls with payors as required. Maintains pricing and other updates within the online ordering system as required. Contacts potential customers to seek new business as directed. Assists in creating and maintaining Supplier Diversity Database including yearly mailing to all Rotech vendors.
Qualification and Experience
Qualifications: Four year degree or equivalent combination of college education and/or related work experience in healthcare, billing, and/or industry contracts. Paralegal training, education or experience desired. 5+ years directly-related experience in the medical industry working with HCPCS, CPT and ICD-9 Codes. Knowledge of Healthcare Contract Language and the ability to read and interpret Contract requirements and guidelines.