Contract Compliance Analyst III

The Contract Compliance Analyst III will facilitate contract implementation and revenue pull-through activities, both proactive and reactive, with internal and external parties. This position will ensure the public and private payer reimbursement. The role is also fundamental in reviewing that billing and payment processes are efficient, timely, and in compliance with corporate goals, contracts and/or regulations. This position will facilitate and manage contract implementation for operations and partner with Managed Care to develop and maintain agreements that provide medical providers and patients with access to our assays while aligning with Exact Sciences goals and objectives.

Location: This is a remote position; candidates must reside in the state of Wisconsin.

• Develop communication for contracts, amendments, and notifications for the internal Revenue Cycle Team (RCT) customers and collaborate with the Field Managed Care team in negotiations with payers for operational optimization.
• Play a role in the development and maintenance of a contract database and contract management system, working with the credentialing and legal teams.
• Collaborate with finance and analytics to identify, analyze, and determine next steps to address negative revenue pull-through scenarios specific to payers and across payer segments; including Medicare Advantage, Blues, Medicaid, etc.
• Collaborate with RCT Managers and specialists to develop and leverage relationships with billing operations staff and payers when resolving claim adjudication issues, both contractual and non-contractual.
• Support execution of pull-through plans to meet quarterly/annual revenue recovery goals.
• Identify broad revenue opportunities that span a particular customer segment; including utilizing Content Management Systems (CMS) for noncontracted Managed Medicare non-payments and the Employer Coalition initiative.
• Consistently identify opportunities to recover revenue.
• Collaborate with the Managed Care team to identify and prioritize plan(s) utilizing key payers for targeted efforts to impact coverage policy decisions.
• Facilitate conversations with appropriate Exact personnel early in the contracting process to provide an overview of the account to avoid delay in implementation down the road.
• Strong attention to detail and organizational skills.
• Strong analytical skills.
• Ability to drive to results with a high emphasis on quality.
• Ability to present recommendations supported by analytical evaluations.
• Strong ability to prioritize and multi-task.
• Ability to integrate and apply feedback in a professional manner.
• Excellent communication, both written and verbal, across internal and external personnel.
• Ability to collaborate and work effectively as a team member.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the Quality Management System team’s policies and procedures.
• Maintain regular and reliable attendance.
• Ability to act with an inclusion mindset and model these behaviors for the organization.
• Ability to work designated schedule.
• Ability to work on a mobile device, tablet, or in front of a computer screen and/or perform typing for approximately 90% of a typical working day.
• Ability to work on a computer and phone simultaneously.
• Ability to use a telephone through a headset.

• Minimum Qualifications:
  3+ years of experience in billing/reimbursement, coverage, claims, and appeals.
• Demonstrated understanding of public and private Managed Care payers and reimbursement process.
• Demonstrated understanding of market-related issues, contract basics, product coverage, and pull through rationale.
• Proficient with Excel and Epic or similar database; demonstrated ability to maintain competency levels.
• Demonstrated ability to perform the Essential Duties of the position with or without accommodation.
• Applicants must be currently authorized to work in country where work will be performed on a full or part-time basis. We are unable to sponsor or take over sponsorship of employment visas at this time.

• Knowledge of and/or experience with government Managed Care payers.
• Knowledge of billing and coding.

In specific locations, the pay range may vary from the range posted.

Originally posted on Himalayas