WVU Medicine · 4 hours ago
Contracting Specialist
Morgantown, WV
Contract
Onsite
Mid Level
4+ years expWVU Medicine is a healthcare provider looking for a Contracting Specialist to manage contract negotiations with insurance companies and other payers. The role involves conducting data analysis, facilitating discussions to resolve payment issues, and maintaining contract files.
Health CareHospitalMedical
Responsibilities
Collaboratively interacts with hospitals and professional providers. Must remain current with how information is collected, maintained and reported in all key systems with direct access to WVUH, UHA, United Hospital Center, City Hospital, and other provider data bases. Facilitates discussions with insurance companies to resolve payment issues and to identify payment, overpayments, and underpayments
Conducts claims extracts and payer payment evaluations to perform contract compliance tests
Communicates and educates others regarding financial improvement analyses, denials issues, findings and recommendations
Evaluates Payer offered hospital and physician financial and non-financial terms. Develops counter proposals. Develops contract language as needed. Works with WVUHS/UHA and non WVUHS/UHA personnel to develop analytical information related to contract negotiations
Maintain and continually improve on technical skills needed to manipulate data. Write programs to utilize the HIPAA compliant 835 reimbursement information. Maintain immediate report writing skills as needed
Writes PC programs, spreadsheets macros and design data base structures as needed to produce and analyze reports
Summarizes offers for review with appropriate HPN, WVUHS, and UHA/WVUPC committees and individuals
Maintains contract files for WVUHS, UHA, WVUPC and HPN
Maintains physician and hospital fee information on major Payers
Maintains hospital contract information on major Payers with selected competitor and benchmark hospitals
Organize meeting materials and attends various organization meetings as needed
Qualification
Required
Bachelor's degree, Health Care Management OR High School Diploma and two (2) years contractual or financial related experience
Four years of experience in data analysis or business management OR two years of work experience in healthcare data analytics, healthcare consulting analytics or healthcare contracting analytics
Understanding of provider and payer contract issues including – Physician, hospital, and other healthcare provider payment terms
Knowledge of roles of IPAs/PHOs in contracting, including basic understanding of antitrust issues as they relate to risk, non-risk contracts, messenger model and direct contracting
Preferred
Master's degree preferred
Direct experience in health care payment methodology for physicians and hospitals or related contracting experience preferred
Knowledge of major West Virginia provider organizations and sensitivity to relative dynamics of West Virginia United Health System and Health Partners Network preferred
Company
WVU Medicine
West Virginia University Health System is a non-profit organization that offers a full range of healthcare services.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Albert L. Wright, Jr.
President and CEO
Zach Kerns
VP of Finance / CFO East Region
Recent News
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