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Contracting Specialist

*ETHOS LABORATORIES* – Newport, KY

LOCATION: This position will be remote, after initial training

HOURS: Monday – Friday, 8:30AM – 5:00PM

EDUCATION AND EXPERIENCE:

  • Bachelor’s degree in a related field (required) OR
  • Equivalent work experience on Payer and Provider side (required)

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

  • Working knowledge of various billing and payers systems
  • Performs portfolio financial analysis on contract activity for laboratory necessary to support the accuracy and profitability of managed care contracting initiatives
  • Prepares financial analysis, performs contract modeling and assists in developing the proposal
  • Aggressively participates in the identification, development, negotiation, and management of provider payor agreements
  • Manage complex contracting and negotiations for fee-for-service, value-based, pay for performance contracts and amendments
  • Lead the rate and language negotiation discussions with the payors
  • Provide strategic leadership around negotiating contracts for closed networks
  • Works with the Company’s Billing Office as needed when rates received by payors vary from the contract.
  • Keep abreast of marketplace changes for payors, networks, reimbursement issues and changes in legislation or in guidelines at the state and federal levels
  • Ensure contract files are in order and kept up to date and archived in compliance with records management policies and procedures
  • Update internal partners on contracting efforts, needs, and process. Provide guidance and training for executed contracts
  • Perform other duties as directed

PROFESSIONAL REQUIREMENTS:

  • Three to five years contracting and negotiating experience involving complex healthcare delivery systems and organizations required
  • Knowledge of Laboratory negotiation and contracting (preferred)
  • Knowledge of complex reimbursement methodologies, including fee for value or incentive-based models strongly preferred
  • Proven portfolio of strong client relationships where an immediate contracting impact can be realized.
  • Experience with analyzing and reporting sales data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions.
  • Understanding and experience with hospital, managed care, and provider business models
  • Excellent time management skills and the ability to prioritize work
  • Attention to detail and problem solving skills

KNOWLEDGE, SKILLS, AND ABILITIES:

  • Ability to communicate effectively, orally, and in writing
  • Skill in completing assignments accurately, timely, and with attention to detail
  • Ability to process and handle confidential information with discretion

PHYSICAL REQUIREMENTS:

  • Work is performed during regular work hours, but may require evening and/or weekend hours to meet deadlines.