At Continental Benefits, our mission is to listen to our clients and members; transform healthcare; deliver remarkable service and sustainable cost savings; and never accepting the status quo. All while being fun and different!
Our employees are our greatest asset and it is their commitment to providing outstanding customer support that has driven Continental Benefits to be a leading provider within the healthcare space. Continental Benefits is focused on developing our employees and we understand that our future growth relies on the talented individuals we hire today.
Come see what Continental Benefits has to offer and find a career you can grow with!
Employees receive personal job satisfaction and purpose while working with Continental Benefits, as well as competitive compensation and employee benefits which consist of:
Medical and Prescription Coverage
Dental and Vision Coverage
Life Insurance
Short Term and Long Term Disability.
401(k) Retirement Plan with Company Match
Paid Time Off
Tuition Reimbursement
Position Summary
Responsible for establishing and maintaining provider contracts (custom and domestic) for preparation, review and/or maintenance to ensure accurate and timely claims adjudication; prepares provider files; maintains provider data (updates, additions, deletions) in our claims processing system; and identifies/assigns providers to the appropriate network(s).
Essential Duties and Responsibilities
• Single Case agreement negotiation and oversight
• Builds custom and domestic contracts for new and existing providers and clients
• Maintains Fee Schedule rates within our claims processing system
• Identifies/assigns providers to the appropriate network
• Responsible for the on-going maintenance of existing providers networks/contracts
• Performs tasks to implement new provider networks/contracts and to maintain necessary networks
• Maintains accurate data to include fees, office locations and contact information
• Downloads CMS and other pricing files for use in the claims processing systems
• Monitors and troubleshoots common and daily tasks, events and changes
• Maintains configuration policies and procedures related to provider contracts and networks
• Analyzes and resolves contract or network configuration issues in a timely manner
• Attends training sessions both internally and externally to enhance knowledge of the claim system
• Assists with testing new releases and upgrades to our claims processing system pertaining to providers/networks, as well as other areas as assigned
• Other duties may be assigned to meet ongoing business needs
• Available during non-business hours to resolve urgent system issues as needed
Qualifications
• In-depth knowledge of claim processing/pricing
• In-depth understanding of multiple pricing methodologies including, but not limited, to DRG, APC and ASC groupers
• Highly organized and capable of focusing on problem details
• Strong documentation and procedural skills required
• Highly developed verbal and written communication skills are essential
• College degree in business or business-equivalent experience.
• 3+ years Third Party Administrator industry experience
• Strong time-management skills and ability to multi-task
• Strong written and verbal communication skills
• Advanced skills with Microsoft Office products including MS Word, MS Excel or equivalent
• Must have exceptional documentation and organization skills
• Energetic and motivated
• Must possess a team-player mentality with focus on collaboration skills
• Skilled in critical thinking
• Skilled in data analysis and recognition of pertinent data elements
• Work with minimum supervision
• Ability to meet deadlines
• Ability to maintain regular attendance
• Ability to maintain confidentiality of material and information
Work Environment / Physical Demands
This position is in a typical office environment which requires prolonged sitting in front of a computer.  Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.  May have occasional high stress when dealing with customers/clients.
EOE M/F/D/V
Experienced Employment Type: Full-Time