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The Contract Compliance Analyst III will facilitate contract implementation and revenue pull-through activities, both proactive and reactive, with internal and external parties. This position will ensure the public and private payer reimbursement. The role is also fundamental in reviewing that billing and payment processes are efficient, timely, and in compliance with corporate goals, contracts and/or regulations. This position will facilitate and manage contract implementation for operations and partner with Managed Care to develop and maintain agreements that provide medical providers and patients with access to our assays while aligning with Exact Sciences goals and objectives.
Job Responsibility:
Develop communication for contracts, amendments, and notifications for the internal Revenue Cycle Team (RCT) customers and collaborate with the Field Managed Care team in negotiations with payers for operational optimization
Play a role in the development and maintenance of a contract database and contract management system, working with the credentialing and legal teams
Collaborate with finance and analytics to identify, analyze, and determine next steps to address negative revenue pull-through scenarios specific to payers and across payer segments
including Medicare Advantage, Blues, Medicaid, etc.
Collaborate with RCT Managers and specialists to develop and leverage relationships with billing operations staff and payers when resolving claim adjudication issues, both contractual and non-contractual
Support execution of pull-through plans to meet quarterly/annual revenue recovery goals
Identify broad revenue opportunities that span a particular customer segment
including utilizing Content Management Systems (CMS) for noncontracted Managed Medicare non-payments and the Employer Coalition initiative
Consistently identify opportunities to recover revenue
Collaborate with the Managed Care team to identify and prioritize plan(s) utilizing key payers for targeted efforts to impact coverage policy decisions
Facilitate conversations with appropriate Exact personnel early in the contracting process to provide an overview of the account to avoid delay in implementation down the road.
Requirements:
3+ years of experience in billing/reimbursement, coverage, claims, and appeals
Demonstrated understanding of public and private Managed Care payers and reimbursement process
Demonstrated understanding of market-related issues, contract basics, product coverage, and pull through rationale
Proficient with Excel and Epic or similar database
demonstrated ability to maintain competency levels
Demonstrated ability to perform the Essential Duties of the position with or without accommodation
Applicants must be currently authorized to work in country where work will be performed on a full or part-time basis. We are unable to sponsor or take over sponsorship of employment visas at this time.
Nice to have:
Knowledge of and/or experience with government Managed Care payers
Knowledge of billing and coding.
What we offer:
paid time off (including days for vacation, holidays, volunteering, and personal time)
paid leave for parents and caregivers
a retirement savings plan
wellness support
health benefits including medical, prescription drug, dental, and vision coverage