Contract Operations Analyst Jobs

Apex Systems is partnering with one of our largest healthcare clients on their new REMOTE Contract Operations Analyst opportunity!

Title: Contract Operations Analyst

Company: Large Healthcare client

Location: REMOTE - Office in Oakland, CA

Duration: Contract through the end of March 2024 with potential conversion permanent

Pay rate: $24-29/hour

Qualifications:

• Medical jargon and coding knowledge – CPT codes
• Professional and non-distracting space to work from home
• Managed care experience – medical billing or claims workflows knowledge
• Excellent communication and ability to collaborate well in a team
• Excellent attention to detail – must have a critical eye
• EPIC experience – specifically within Tapestry is a plus

Responsibilities:

• Working through 3rd party group to define the terms – but rate structures are fairly static.
• Owning the CDID process - Contract design interpretation document
• CBAS – Community Based Adult Services: For elderly care primarily, Go to base center to get support for their healthcare needs
• Interpret the legal jargon to create a CDID to configure a database (Tapestry) correctly to ensure the documents rates are captured correctly in Epic Tapestry. Some contracts are more complicated, and the contract terms/claims payment terms can’t simply be interpreted w/o manual work by a claims processor/adjudicator.
• Intention is to provide a simple rate structure to these providers (example provider below)
• This group will receive the final approved version of the contracts, and their work is to develop the CDID, which is uploaded to the Database.
• Mostly interpreting Professional services contracts from third party providers of services. Community providers/practitioners.