What are the responsibilities and job description for the Contract Specialist position at Government Employees Health Association, Inc. - GEHA?
GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees.
GEHA has one mission : To empower federal workers to be healthy and well.
Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization.
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.
SKILLS
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 staffin regards to projects associated to Accreditation.
Other duties as assigned
Requirements : Education & Experience
Requires two years of college (60 credit hours), additional years of qualifying experience may be considered in lieu of education.
Requires three years health or dental-care, insurance administration experience or similar.
Requires effective verbal and written communication skills to respond to members, providers, network vendors, internal contacts and GEHA Management.
Requires knowledge of MS Excel and Access.
Requires analytic skills to evaluate network, provider and member data.
Candidates must reside in KC metro area.
Work-at-home requirements
- Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
- A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
- Latency (ping) response time lower than 80 ms
- Hotspots, satellite and wireless internet service is NOT allowed for this role.
- A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
How we value you
Please note that the salary information is a general guideline only. GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate's work experience, education / training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.
The annual base salary range for this position is $57,934 - $81,666 USD.
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. Our diversity drives innovation deepens connections and strengthens our organization.
GEHA is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.
Salary : $57,934 - $81,666
