"Alerted.org

**Facility:** Corporate Offices

**City** San Diego

Department

Job Status

Regular

Shift

Day

FTE

1

Shift Start Time

Shift End Time

Hours** **:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$32.730 - $40.910 - $45.810

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

**Please Note:** As part of our recruitment process, you may receive communication from Dawn, our virtual recruiting assistant. Dawn helps coordinate scheduling for screening calls and interviews to ensure a smooth and timely experience. Rest assured, all candidate evaluations and hiring decisions are made by our recruitment and hiring teams.

What You Will Do

Supports SCMG with analyzing the SCMG contractual terms, ensuring the Epic system is setup accurately and maintained, and provides data and financial analysis for its providers. The Contracts Analyst is responsible for operational support to respond to contract informational needs; analyzes contractual claims processing and compensation terms of Primary Care, Specialty, and Ancillary contracts; audits system set up for accuracy; etc.

Required Qualifications

+ 3 Years experience with healthcare claims, reimbursements, and/or contracts.

+ 2 Years experience in a Managed Care environment.

Preferred Qualifications

+ Epic/Tapestry experience.

Other Qualification Requirements

+ Bachelor's degree in business, accounting, or healthcare administration; or 4 years of relevant experience in contract or claims administration may substitute for degree. - REQUIRED

Essential Functions

+ Contracting SupportResponsible for requesting, preparing and analyzing data necessary for contract negotiations; develop reports necessary to determine contract performance compared to budget or established standards.Assist in the development and maintenance of communication links throughout SCMG and Sharp system to identify reimbursement issues and participation in the development of action items for resolution.In addition, communicate current contract information.Provides feedback to the SCMG Contracts team as it relates to required contractual changes to ensure compliant and timely claims processing and reimbursement.Responsible for generating SCMG Contract Verification Form (CVF) document for every contract addition, change and termination.

+ Contract Implementation and MaintenanceAssures contract information is communicated and coordinated to appropriate internal departments and audit is performed to ensure accurate contract claim/encounter pricing and other reimbursement terms are in effect.Creates and maintains the contract matrices for the system setup and ensures proper claims adjudication in collaboration of the Epic/Tapestry claims support team, which includes auditing Epic/Tapestry claims system set up to verify appropriate and correct reimbursement.Keeps SCMG abreast of Epic/Tapestry system updates and changes as it relates to the processing of professional claims.Monitors provider reimbursement issues regarding any contract disputes and report to the Contracts Manager.

+ AuditsPerforms ongoing and ad hoc audits of the claims processed to ensure accuracy and appropriateness of claims payments and denials.Perform quarterly audits of contract reimbursement performance in relation to contract terms for ancillary, primary and specialty care providers.Provides support for regulatory claims audits to the various SCMG departments and the Sharp HealthCare claims department.

+ Other DutiesProvides support to the Appeals and Grievances team as it relates to claims processing and the Epic/Tapestry setup.Assists in project coordination with other SCMG departments: Claims, Utilization Management, Network Management and Pharmacy Benefits.Maintains service orientation to representatives of SCMG through consistent assessment of needs and timely response to requests.Develops and maintains relationships with contract representatives in support of SCMG and ensure timely response to contractual issues and contract compliance problems.Assists with other duties as assigned to be completed in an agreed upon format and in an agreed upon time frame.

Knowledge, Skills, and Abilities

+ Ability to analyze and interpret data and outcomes of the Epic/Tapestry system.

+ Strong working knowledge of claims processing, contract adjudication, and CPT/ICD 10 and HCPCS coding.

+ Ability to maintain good working relationships with Physician and Provider representatives is critical and is required.

+ Demonstrate analytical ability in a health related or claims adjudication system environment.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class