Summary

Responsible for the participation in translating the provider contracting into System set-up for accurate data maintenance within HPS systems, including provider demographic data and fee schedule analysis for Health Plan Services (HPS) along with HPS Business Analyst. Investigates fee schedules and reimbursement methodologies and participates in developing pricing recommendations, including but not limited to claims processing validation for accuracy against system(s) set-up, fee schedules review, and review of contract issues. Responsible for verbal and written communication to Contract Specialist and Manager, as well as to the provider network. Delivers outstanding customer service to internal and external customers.

Education

Must have a Bachelor's degree in a health care or finance related field.

Licensure/Certification

Must have a valid state issued driver's license

Experience

Must have at least four years of comprehensive experience in managed healthcare, provider relations, project management, medical informatics, utilization management or physician office experience.

Other Qualifications

Must have excellent verbal and written communication skills. Must provide own transportation; Will be required to work outside the office approximately 5% of the time. Must demonstrate excellent time management skills and leverage opportunities to work hybridly from home or the office effectively.