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Provider Network Analyst

Maumee, Ohio
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Description

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.

 

Position Summary

The Provider Network Analyst assists in creating and maintains provider fee schedules and associated reimbursement changes. Along with creating and maintain fee schedules, this position is assists in communication with other department staff on quality assurance needs. As well as communication with other departments on needed fee schedule updates. This position also supplies data to other departments as needed. 

 

Accountabilities

1. Responsible for fee schedule creation, updates, and evaluation (including, but not limited to, Physician, DRG, Per-Diem, Home Health, Hospice); Ensure accurate and timely implementation of fee schedules while coordinating with other departments to ensure fee schedule accuracy. 
2. Responsible for completion of financial impact analysis reports relative to fee or rate changes. 
3. Responsible for the calculation of annual rate revisions based upon each provider’s charge increase and charge increase maximum. 
4. Assists with the development, implementation, and maintenance of action plans and assists with efforts to implement network-pricing strategies. 
5. Assists with the completion of data requests for Marketing RFP processes related to fee schedules and participating providers. 
6. Handle day-to-day inquiries regarding hospital or physician payments; Research as appropriate. 
7. Work collaboratively with other departments in the configuration of contracted rates in Paramount’s Claim Adjudication System. 
8. Other duties as assigned. 
 


  • Education: Bachelor’s degree required, in healthcare or business related field. 
  • Skills:
    • Excellent written, verbal, and organizational skills required.
    • Demonstrated understanding of DRG, CPT, UB, ICD-10 coding concepts, and medical benefit payment systems required.
    • Experience in automated information systems and hands-on experience using computers for Microsoft Excel spreadsheet applications required.
    • Experience with Microsoft Access database and Microsoft Word processing applications and end-user reporting required. 
  • Years of Experience: 1 year relevant work experience in developing and understanding provider fee schedule and reimbursement changes 

 

Preferred Qualifications

  • Skills: Knowledge of AMISYS or Health Edge claim adjudication software is preferred. 
  • Years of Experience: 1+ year business experience required; experience in a hospital or insurance industry strongly preferred. 

 

Physical Demands

Ability to communicate on telephones; operate computers and general office equipment; ability to travel independently through Paramount service area.

 

ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

Equal Opportunity Employer/Drug-Free Workplace

 

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