Providence St. Joseph Health is calling a Contract Specialist RCS PSJH to work remotely within our footprint states: AK, CA, MT, OR, TX and/or WA.
We are seeking a Contract Specialist RCS PSJH to be responsible for understanding, interpreting and addressing complex issues arising from payer agreements. Intakes payer escalations, develops action plans and coordinates issues with payer representatives. Responsible for maintaining the accuracy and integrity of the payer escalation reporting and documentation on the shared drives. The role is expected to work independently and is accountable to make timely knowledge-based decisions related to the payers and operational practices. The Contract Specialist also maintains comprehensive knowledge of payer contracts and policies across all states served to ensure compliance is maintained.
Promotes an environment shaped by health, healing, hope, diversity, and mutual respect.
In this position you will have the following responsibilities:
Works closely with key stakeholder to resolve operational issues in specified time frames related to payer contracts.
Track issues identified by Revenue Cycle and other stakeholders, where system is unable to be set up correctly to administer language correctly. In collaboration with key stakeholders, develop correction action plan.
Review patient accounts to determine the correct expected reimbursement per the provider contract terms and perform analysis on payments that have been received .
Strong communication skills, both written and oral required to research, identify root cause by communicating at various levels within the organization, consolidating the issues, and sharing the resolution.
Strong organizations skills required to manage and prioritize work including multiple priorities at the same time. Tracking and communicating current workload and open issues on a regular basis to key stakeholders and leaders.
Support routing of contractual questions and issues to Payer Contracting.
Strong understanding of contract structure and terms. Serves as facilitator for the resolution of contract interpretation. Interfaces with payer contracting on disputes related to contract interpretation.
Attention to detail required for the implementation of the executed agreements, including ensuring downstream departments impacted have been notified.
Facilitate payer performance reporting for all Revenue Cycle leaders and PSJH ministries.
Conduct regular meetings with payers to discuss the details and status of escalated issues and performance across the PSJH ministries.
Provide training to business office staff on payer contracts.
Supports the annual payer contract renewal, CDM and payer notification process , if applicable.
Perform other duties as assigned.
Required qualifications for this position include:
H.S. Diploma or GED or equivalent education/experience
2 years experience with payer billing, collections and reimbursement methodologies, and contract language requirements
Preferred qualification for this position includes:
- Bachelor's Degree in a closely related area or equivalent education/experience
About the department you will serve.
One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence Health & Services (PH&S) in revenue cycle systems and structures in support of our ministries and operations in all regions from Alaska to California. ORC’s objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise.
We offer a full comprehensive range of benefits — see our website for details — http://www.providenceiscalling.jobs/rewards-benefits
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Contracting
Other Location(s): Montana, California, Washington, Oregon, Texas, Alaska
Req ID: 345741