salary: $80 - $100 per hour
work hours: 8 AM - 4 PM
- Ensure provider rates are accurately maintained and updated within the benefit plan and contracts in the Trillium Business System (TBS)
- Maintain knowledge of internal and external healthcare fee schedules and analyze comparable provider rates from other payers
- Conduct internal audits on current payment arrangements with providers to ensure accountability with established guidelines and contract requirements
- Develop and maintain process flows with internal departments for payment arrangements with all provider contracted services.
- Work closely with clinical operations and the Strategic Financial Manager to analyze payment methodologies for In Lieu of Services and Alternative Payment Arrangements.
- Update and track provider and member specific enhanced rates by specific categories of service as defined by the North Carolina Department of Health and Human Services (NC DHHS).
- Complete service rate changes and initializations in provider contracts.
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