Payor Contracts Administrator (Managed Care Contract Administrator)
Carlsbad, CA 
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Job Description
Description

Are you looking for an exciting opportunity?

We currently have a full-time opening for Payor Contracts Administrator. This position is a work-from-home opportunity anywhere is in the US. If you are looking for a fast-paced environment where you can make a difference every day, then this is the opportunity for you!

The right person to join our team...

Demonstrates ownership and accountability as well as the ability to: plan, execute, control and deliver; communicate effectively both written and verbal; lead and influence others effectively. Must be willing to quickly learn product features and benefits. Must be flexible and demonstrate energy and desire to overcome obstacles.

This position is responsible for....

  • Reviewing, revising, and analyzing payor contracts.
  • Implementing systems and use software designed to ensure accurate tracking and recordkeeping regarding the fulfillment of contractual obligations.
  • Serves as the Subject Matter Expert in Payor Contracts Administration using knowledge of the regulations governing payor contracts.
  • Supports the Payor Contracts leadership as required, including the creation of payment and usage history reports for either insurance, doctor, DME contractor and/or patient payor accounts.

Your day will be very busy... you will:

  • Maintains and validates the Insurance Payor Databases in Brightree and the Breg Claim System (BCS).
  • Initiates requests to contract. Reviews contract language and pricing requests for approval by the Director, Payor Contracts. Assists with appropriate changes to proposals and/or contracts as directed.
  • Reviews Insurance Contracts to preclude inconsistencies in pricing, claim submission, medical policies and reimbursement procedures, etc. as set forth in the payor provider manuals.
  • Completes credentialing applications and provides supporting documentation to maintain and/or secure the payor contract or enrollment with a State agency.
  • Works with sensitive and confidential material that represent an immediate and possibly long-standing financial impact on the company.
  • Ensures that all claims submission guidelines including preauthorization requirements, timely filing/appeal limits and terms and conditions are uploaded and/or implemented into the appropriate databases.
  • Maintains the standard insurance database information for current listings or additions as requests are received.
  • Reviews updated in-house insurance reports to:
    • Verify that the billing information on the reports is correctly stated in the database.
    • Validate pricing (contracted or non-contracted) and ensure that the listing is accurate within the payor database.
    • Maintain thorough communication with on-shore and off-shore billing teams for all questions concerning the payor database.
  • Supports the Billing Operations with claims processing set-ups including EDI, EFT and ERN, answers questions on website portals and assists with billing projects as assigned.

What your background will be:

  • Bachelor's degree preferred and 2+ years' experience processing payor contracts and agreements.
  • Familiarity with Healthcare reimbursement regulations.
  • Computer proficient to include web browser/internet search, MS Outlook, MS Office to include Advanced Excel skills and the ability to produce presentation-ready slides in PowerPoint. Technical competence includes the ability to learn new software and systems.

For six consecutive years Breg has been awarded The National Business Research Institute (NBRI) Circle of Excellence Award for employee engagement AND Breg has been awarded as one of the Best Places to work in San Diego in 2014 by "The U-T San Diego Top Workplaces"

If you meet the requirements above and would like to apply for this position, please visit our website at www.breg.com and click on the 'Careers' section.

Breg is an Equal Employment Opportunity Employer and dedicated to a diverse work force and Drug Free work environment. EOE/Minorities/Females/Vet/Disabled are encouraged to apply.





 

Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
2+ years
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