Contract Resolution Specialist

Job Description:

• Assist network providers with contractual issues
• Act as a trainer/educator on CoxHealth Network contracts for network providers and their staff
• Organize and host meetings when required
• Perform initial and recredentialing on-site reviews and chart audits for providers as needed
• Resolve contracts and deliver and interpret policy and procedure changes related to specific contracts
• Communicate regulatory changes related to the insurance industry as needed
• Research new technology related to payors' medical necessity and coverage
• Maintain contacts and provide educational information to network, tertiary/affiliate PHO networks impacting over 3,000 providers/facilities
• Organize, prioritize, and multitask to execute projects and daily workflow

Requirements:

• High School Diploma or Equivalent
• 3-5 Years experience working in the provider office, healthcare billing, healthcare insurance and/or Managed Care industry
• Ability to understand complex multi-provider payor contract agreements and determine compliance standards are being adhered to
• Must be a self-starter and work with minimal supervision
• In-depth working knowledge of managed care plans and CoxHealth contracts
• Understanding of the legality of the messenger process used for independent providers
• Ability to analyze and communicate contractual terms and requirements to providers
• Local travel required
• Preferred: Bachelors in a Related Field
• Preferred: Previous experience in provider relations and/or physicians office management

Benefits:

• Medical, Vision, Dental
• Retirement with Employer Match
• Benefits eligibility for employees working 20+ hours/week