Conifer Health Solutions · 13 hours ago
Terms & Conditions Analyst - Remote
United States
Full-time
Remote
Entry, Mid Level
$22.56/hr - $33.85/hr
1+ years expConifer Health Solutions is a healthcare company that provides expertise to clients in various regions. They are seeking a Terms & Conditions Analyst responsible for analyzing healthcare insurance reimbursement contracts, making recommendations during negotiations, and ensuring accurate pricing in contract profiles.
Health Care
Responsibilities
Analyzes the Contract Terms and Conditions in a timely manner and makes recommendations for new contract loads, formulates, and implements amendments and changes, and rollover contracts as part of the client audit, deviating from established procedures as necessary
Regularly exercises discretion in analyzing and identifying issues associated with reprice impact reports after communication log issue have been corrected and re-priced. Formulates and implements solutions to identified issues and is empowered to make exceptions when required to move issues to resolution
Independently audits and verifies post-contract changes
Collaborates with Client Managed Care and Med Assets Account Rep to ensure contract profiles are pricing accurately, per contract language
Reviews internal requests for assistance and executes work list/queries for newly opened communication logs. Documents affected accounts as required
Identifies alternative opportunities in contract interpretation and revenue routing through the analysis of issues and, acting as a subject matter expert, provides alternative recommendations to management and staff. Activation of plan ID’s in mainframe system and MedAssets complying with NIC standards. Request approvals from Managed Care for NCCI edits if stated in contract and forward to the appropriate parties for loading
Communicates with appropriate leadership to ensure discrepancies are resolved prior to close of month end
Qualification
Required
Minimum 1 year contract interpretation experience required
Advanced understanding of hospital billing form requirements (UB-04)
Advanced understanding of ICD-9, HCPCS/CPT coding and medical terminology
Advanced Microsoft Office (Word, Excel)
Advanced knowledge of query writing applications a plus
Advanced managed care/government contract interpretation skills
Strong analytical abilities
Preferred
Bachelor or Associate Degree preferred
3-5 years of relevant hospital business office experience preferred
Benefits
Medical, dental, vision, disability, and life insurance
Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
401k with up to 6% employer match
10 paid holidays per year
Health savings accounts, healthcare & dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.
Company
Conifer Health Solutions
Conifer Health Solutions is a healthcare services company helping organizations strengthen their financial performance
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Brian Murkowski
HR Business Partner
David Buchanan
Talent Acquisition Partner
Recent News
2025-11-19
2025-11-19
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