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Change Healthcare Client Contract Modeler - Remote (Anywhere US) in Des Moines, Iowa

Client Contract Modeler

Overview of Position

The Client Contract Modeler is responsible for reading/interpreting and evaluating hospital contracts with Insurance Companies based on language content, rates, terminology, and reimbursement methodology as well as setting them up in our contract modeling software to determine if the payer is paying according to hospital contract.

Developing professional expertise, applies company policies and procedures to resolve a variety of issues. Works on problems of moderate scope where analysis of situations or data requires a review of a variety of factors. Exercises judgment within defined procedures and practices to determine appropriate action. Builds productive internal/external working relationships. Normally receives general instructions on routine work, detailed instructions on new projects or assignments.

What will be my duties and responsibilities in this job?

  • Read, interpret, and evaluate hospital contracts with Insurance Companies based on language content, rates, terminology, and reimbursement methodology.

  • Accurately write, categorize, and use analysis of hospital contracts in Coding translation into Contract Management Systems.

  • Perform necessary contract link maintenance, updates and modifications associated with contract/amendment changes.

  • Execute rules testing to verify accuracy of written contract rules. Screen Clients’ online systems for: published Payor Mix changes; new, modified and/or updated contracts/agreements/amendments, and fee schedule and/or table updates.

  • Timely, assemble Clients’ Payor contracts and updates.

  • Assist with trend reporting, including looking for other areas of opportunity based on Trend Reporting.

What are the requirements needed for this position?

  • 3+ years of related experience in hospital or Health Insurance Company in Provider Relations, Contract Management, Configuration, or other related Health Care Revenue Cycle functions

What critical skills are needed for you to consider someone for this position?

  • Strong insurance company/hospital contract experience.

  • Ability to prioritize workload and flexibility to work on several projects at one time.

  • Ability to work independently with minimal supervision.

  • Excellent contract interpretation skills including understanding of rates, amendments, reimbursement methodology, terminology, and strong comprehension of insurance industry process, procedures, and limitations.

  • Ability to multitask and set priorities.

  • Knowledge of Medicare/Medicaid and Medicare/Medicaid HMO.

  • Basic Excel skills including data sorting/filtering, data validation, formula’s, pivot tables, VLOOKUP’s, etc.

What other skills/experience would be helpful to have?

  • Strong communication skills

  • Organizational skills and attention to detail

  • Analytical and problem-solving skills

What are the working conditions and physical requirements of this job?

  • General office demands/Home office

How much should I expect to travel?

  • No travel required

    Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system!

COVID Mandate

As a federal contractor, Change Healthcare is adhering to the Executive Order which mandates vaccination. As such, we are requiring all U.S. new hires and employees to show proof of being fully vaccinated for COVID-19 or receive an approved accommodation by their date of hire, as a condition of employment.

As we continue to navigate the ever-changing COVID-19 pandemic, we remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. Proof of vaccination or accommodations requests will be collected once an offer is accepted with Change Healthcare. All accommodation requests will be carefully considered but are not guaranteed to be approved.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to applyaccommodations@changehealthcare.com with "Applicant requesting reasonable accommodation" as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information (https://www.changehealthcare.com/privacy-notice/privacy-notice-to-california-job-applicants) .

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.

Change Healthcare is an equal opportunity employer. All qualified applicant will reveive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status.

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