How You’ll Help Transform Healthcare:
Assists with research, negotiation, development, and maintenance of managed care contracts.  Strategic activities include extraction and evaluation of data, creation of reports and submission of recommendations for improvements related to: contract formulation, negotiations with payers, performance monitoring, billing and collections and legal compliance. In conjunction with senior staff, responsible for performing application system analysis and design specifically for contract implementation and contract compliance.  Includes knowledge of application requirements, specifications, configurations, documentation requirements, and the testing and implementation of applicable applications. Will be required to make timely, effective decisions using independent judgment and discretion within the appropriate guidelines defined by leadership.
• In conjunction with senior staff, performs contract reviews, analyzes proposals, and identifies issues that would impair successful implementation of a new contract. Makes recommendations for changes prior to negotiations and assists in negotiations, as requested.
• Assists in contract review analysis and identification of issues that are not in compliance with existing contracts. Makes recommendations for improvements.
• Performs initial analysis of advanced application design including, but not limited to, planning implementations and maximizing application benefits. Develops and maintains a comprehensive working knowledge of  applications and related development and maintenance tools.
• Acquires functional  working knowledge of all billing areas, including but not limited to, Facility, Professional, Behavior Health and Home Health. Functional knowledge demonstrated by an understanding and use of the principals, theories, and practices pertinent to the work specialty; proficiences and certifications may be  required.
• Develops a working knowledge of business needs and application functionality, in order to define system requirements and develop detailed system design. In conjunction with senior staff, develops and recommends changes to tables, configuration files, or programs to meet business needs and/or improve application functionality. Identifies opportunities for maximizing application benefits.
• Assists in planning and conducting quality assurance testing, analysis and validation as needed. Identifies and reports perceived risks and suggests potential resolutions.  Performs effective troubleshooting and logical analysis to identify and resolve technolgy issues. Resolves issues of minimum complexity independently seeking assistance of senior staff when needed.
• Develops and maintains computer application files, contract files and supporting documentation as needed.
• Designs and develops proposed processes and advises on workflow changes that may maximize system benefits.
• Adheres to the application change management process to include timely reporting of all pertinent change information, effective discussion of the changes, internal and external communications, contingency planning, support of the change event and post-change reporting, as appropriate.  Supports RCM administration in projects.
• Demonstrates competence to interpret and communicate information, ideas, and instructions.
• Prepares status reports and other documentation requested by management in a timely manner.
What We Require:
Education: BS in computer, healthcare or business related field or 6 years equivalent work experience required.
Experience: 2 years of related experience required demonstrating: Analytical and problem solving skills, Clear, effective communication skills, Detail orientation, Proficiency in PC.
Licensure/certification: MPV proficiency and MPV access to basic and contract modules preferred.  CPC desired, but not required.
Other Minimum Qualifications: Working knowledge of managed care contractual terms and requirements, health insurance practices, industry regulator requirements, business office operations, patient registration, billing and accounts receivable functions, financial reporting technology and industry standards for healthcare revenue resolution management practices. Must be a self-initiated team player with strong organizational and analytical skills. Must be able to work both independently and in a team setting. Must be capable of prioritizing multiple projects and meeting deadlines. Effective oral and written communication, presentation and problem solving skills required.
About Carilion
This is Carilion Clinic ...
An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.
Requisition Number: 139880
Employment Status: Full time
Location: CASB - Carilion Administrative Services Building
Shift: Day
Shift Details: M-F 8-5/Hybrid
For more information, contact the HR Service Center at 1-800-599-2537.
Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity
Carilion Clinic is a drug-free workplace.