What are the responsibilities and job description for the Contract Specialist position at Claritev?
At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all our stakeholders – internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.
Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!
Contract Specialist
JOB SUMMARY :
This role is responsible for handling pre-claim and OON physician contract negotiations for all clients coupled with reaching out to senior management at facilities across the country to secure lowest settlement rate.
JOB ROLES AND RESPONSIBILITIES :
1. Handles facility, provider and client inquiries, regarding pre-claims and OON physician contract requests; including correspondence.
2. Secures signed agreements for reimbursement with providers.
3. Researches claims to confirm our history with the provider
4. Determines cost saving opportunities and pricing optimization strategies.
5. Contacts providers to discuss pricing in order to ensure patients can have services rendered.
6. Maintains relationships with central providers.
7. Ensures clear documentation of events associated to a claim resolution.
8. Provides updates and solicits required information from clients as needed.
9. Keeps direct report informed of critical matters that impact responding timely to pre-claim or physician contract requests.
10. Manages a daily running inventory of claims, prioritizing one's work schedule accordingly.
11. Addresses emails and incoming calls.
12. Collaborates, coordinates, and communicates across disciplines and departments.
13. Ensures compliance with HIPAA regulations and requirements.
14. Demonstrates Company's Core Competencies and values held within.
15. Please note due to the exposure of PHI sensitive data this role is considered to be a High Risk Role.
16. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and / or assigned as necessary.
JOB SCOPE :
This position works independently under minimal supervision to complete the assigned job responsibilities. Work performed is often varied and complex requiring a reliance on a knowledge base built through experience. The incumbent follows established procedures and uses knowledge of the company's general business principles, industry dynamics, market trends, and specific operation details when performing the duties of the position as assigned.
