What are the responsibilities and job description for the Contract Specialist position at GEHA, Inc.?
Summary
Provides technical oversight to Health and Business staff on correspondence and contracts, responding to questions, complex service issues, demographic data and workflow issues. Assists department with special projects, implementation and execution of new programs and processes. Analyzes department production reports, turnaround time and various department data.
Duties
- Review production and quality results to ensure that department standards and goals are being met. Develops and prepares daily, weekly or monthly reports as needed.
- Make adjustments to tracking software as needed.
- Researches network service issues. Tracks priority issues and appeals. Coordinates with Senior Contract Specialist and supervisor to determine appropriate action needed for resolution or resolves issues.
- Analyzes and investigates par / non-par, balance billing, member appeals, provider appeals and quality assurance issues and coordinates with appropriate parties to resolve issue.
- Works with Senior Contract Specialist or Supervisor to implement workflows related to implementation activities.
- Create and make changes as needed to network management desk level procedures.
- Review Network reports for potential non-compliance of access to care requires needed to meet OPM contractual requirements.
- Identify error trends and determine training needs. Create documentation and facilitate this training as needed.
- Assist with projects resulting from network pricing adjustments, GEHA system issues, and benefit changes. This includes determining appropriate workflow, resources needed and coordinating with internal departments to insure minimal impact to payers or clients.
- Work with Senior Contract Specialists to review audit results and appeal when issues are identified.
- Address daily reports received from internal GEHA areas, leased networks including, but not limited to network claim reports.
- Provide support to GEHA staff in regards to projects associated to Accreditation.
- Other duties as assigned
