Healthcare Claims Contracting Specialist

ABC Medical is one of the nation’s leading urological supply providers, and serves as a one-stop shop with a comprehensive line of medical supplies and service that includes : Urological, Incontinence, Wound Care, and Ostomy.

ABC Medical is part of the JDS, Inc family of businesses. Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services.

Work Location : Remote

Remote

Candidates must reside in one of the following states : Florida, Georgia, Virginia, Pennsylvania, Ohio, Tennessee, Alabama, Illinois, Minnesota, Arkansas, Texas, Colorado, California, Washington

Hours : 8 : 30 - 5 : 00pm Local Time

You Will (Responsibilities) :

The Contract Administrator provides oversight, management, coordination, organization, and communication of payor contracting activities for each of the ABC Medical family of companies.

The Contract Administrator is responsible for maintaining all company payer agreements, addendums, renewal terms, and required notification or due dates.

The position interprets all payer requirements and ensures that those requirements are systematically implemented in company operating processes.

The Contract Administrator manages the payer contract process and collaborates with the sales team and internal departments to ensure staff are informed of contracting status.

Key factors include supporting the sales growth by developing new contracts with payers and expanding contract coverage to pursue profitable business growth.

• Pursue, negotiate, and maintain contracts with all payers, e.g., insurance companies, IPAs, TPAs and government programs.
• Understand insurance policies and regulatory guidelines to implement systematic parameters to ensure compliance with payer-specific rules and requirements.
• Provide expertise and support to internal departments regarding specific payer guidelines and contractual inquiries.
• Understands and identifies profitability opportunities within assigned payers.
• Facilitate the payer contracting process and ensure accuracy of all contract documents from pre-contract through post-contract phases.
• Works with legal, credentialing and all relevant involved teams to ensure contracts are compliant.
• Provides contract summaries and ensure contract execution in accordance with company policy.
• Supports providing a monthly report to senior management and organizational stakeholders with progress and status of contracted payor agreements.
• Supports the maintenance of a common provider directory / database for enrollment with payers.
• Supports the research of territories to identify gaps in payer base to support contract expansion.
• Assist with all contracting administration and projects, as needed.

Minimum Qualifications :

• Associate or bachelor’s degree, or 5 years of relevant healthcare contract experience
• Ability to interact professionally and ethically with team members, all levels of management, government agencies, and insurance payer personnel
• Ability to manage multiple tasks simultaneously in a fast-paced environment
• Ability to provide clear, concise oral and written communications
• Ability to handle special requests in a sensitive, professional manner
• Strong attention to detail and follow through skills
• Meticulous organization and filing skills

Preferred Qualifications :

• Experience working at a medical insurance company, IPA, TPA highly preferred
• Familiarity and experience with DME and / or Medical Supply reimbursement, including Medicare, Medicare Managed, Medicaid, and Medicaid Managed plans.
• Knowledge and use of Brightree software preferred but not required.
• Advanced Microsoft Office experience
• Ability to troubleshoot complex payor events

Here’s what we have to offer :

• Variety of Medical, Dental and Vision Insurance Plans
• 401k Plan with Company Match
• PTO and Paid Holidays
• Employee Discounts

The anticipated base salary range for this position is $55,190 - $102,496. The actual salary varies based on applicant's location, education, experience, skills, abilities, and other legitimate business factors.

The Company also provides a unique Benefit of Employee Share Ownership Program (BESOP) program.

• The Company’s health and welfare benefits include : medical, prescription, dental, vision, spending / savings accounts, disability, statutory leaves / disability programs, accident, life, wellbeing, and voluntary benefit programs.
• The Company’s 401(k) Retirement Savings Plan includes : vesting and eligible participants safe harbor matching contributions.
• The Company’s paid time off benefits include : 8 paid holidays and paid vacation based on length of service and exempt / non-exempt status.

To make life more rewarding and dignified for the people who use our products and services.