Description
GENERAL SUMMARY OF DUTIES: The RCM Senior Contract Specialist will be responsible for loading all Professional, Facility, and Ancillary contracts across all lines of business in a timely and accurate manner. This individual will provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement. The Contract Specialist collaborates on workflows and business processes to ensure efficient interaction with RCM, Analytics, and other business areas to facilitate accurate translation and maintenance of contractual agreements. Develop expertise in the downstream impact of loaded rates within Senta's full claims reimbursement cycle.
Responsibilities:

• Engage fully in the configuration of provider, facility, and ancillary rates within the Network, adhering to strict deadlines and guaranteeing the complete accuracy of contract loads.
• Work in collaboration with Network Management and Analytics to guarantee the accurate capture of negotiated and modeled contractual agreements. Identify and resolve rate loading issues to ensure that contracts are precisely reflected in the system.
• Assistance is provided for contract configuration, fee schedule/grouper, and rate reimbursement issues. Negotiated contracts are analyzed to ensure that the network's interaction with core systems aligns with the intended reimbursement terms.
• Recommend changes to contract language to align with system reimbursement capabilities. Ensure contract file setups, maintenance, testing, and auditing are conducted as necessary.
• Establishing and accomplishing business strategies to successfully translate contractual language into system reimbursement specifications
• Excellent knowledge of medical terminology, Fee Schedules, and ICD/CPT/HCPCS coding required
• Understanding of Government reimbursement methodologies required
• Focus on EMR charge masters and fee schedules
• Works closely with Director of Contracting to understand contracts including fee schedules, effective dates and expiring dates
• Works in close collaboration with EMR administrators to ensure the provision of properly approved fee schedules and charge masters for each practice, indicating their application to specific locations and providers. Additionally, conducts reviews of the EMR's automatic loading of the annual Medicare fee schedule to verify its accuracy.
• Review regular Medicare adjustments with analysts for accuracy
• Works closely with FP&A analysts to review the impact of changes in charge masters and fee schedules
• Works closely with FP&A analysts to review actual collections vs fee schedules
• Works closely with RCM leaders on review of actual collections vs fee schedules
• Works closely with VP of RCM to approach payors with discrepancies in actual payments vs fee schedules
• Maintains organized fee schedule files - including practice, locations, providers, effective dates, expiring dates
• Monitors and communicates expiring dates timely

Required Education, Skills, & Experience
Bachelor's degree in healthcare administration, Business, Finance, or related field or equivalent experience in healthcare. Minimum of 5 years of experience in healthcare reimbursement (RCM) In-depth knowledge of healthcare industry, payer relations, and functional compliance regulations and standards required. Previous experience managing people required. Demonstrated experience leading teams required. Strong understanding of business strategies and drivers, particularly in a sales organization. Exceptional problem-solving skills needed. Must be computer literate and able to operate both EMR system and multiple Microsoft Office Applications.
Additional Skills and Experience
MUST HAVE FOR SUCCESS:

• Excellent organizational skills and attention to
• Analytic, problem solver, excellent organizational and technical skills and attention to detail are required
• Excellent time management skills with a proven ability to meet
• Ability to deal with patients, visitors, co-workers, and physicians with courtesy and
• A professional outgoing warm and helpful attitude
• Demonstrated proficiency in analytical, statistical, and business intelligence tools.
• Demonstrated organizational and communication skills and ability to work with detailed financial information with accuracy and confidentiality.
• Demonstrated communication skills with a variety of audiences, including department management, organizational leaders, physicians, and staff members using presentations, spreadsheets, and written documents.
• Strong organizational and analytical skills
• Ability to multi-task and work both independently and within teams

Equal Opportunity Employer
Senta Partners is an Equal Opportunity Employer and does not discriminate based on race, religion, gender, color, or national origin in its employment practices.