Contract Analyst

Zelis • Plano, TX

1d • Hybrid

About The Position

This position requires an incumbent to analyze healthcare reimbursement contracts and load contract terms between payers and providers in an accurate and timely manner using proprietary software. This position reports to the Manager of Contract Configuration and will collaborate with the programming and development teams in the creation and vetting of calculation methods, database loads, or changes. This position is an internal resource to staff and clients and as such is expected to respond to client issues and cases in a timely manner.

Requirements

• 4+ years of relevant experience
• Bachelor’s Degree or equivalent work experience in Healthcare Revenue Cycle Management/Contracting field
• Microsoft product proficiency. Must be an intermediate to expert user of Excel
• Possess strong analytical and math skills
• Self-Motivated and Detail Oriented
• Effective written and verbal skills, communicate effectively & expresses ideas clearly and succinctly.
• Seeks opportunities for continuous learning. Modifies behavior in response to feedback.
• Delivers high quality work and attains results.
• Prioritizes the importance of tasks and goals.
• Manages time efficiently to accomplish priorities and overcome obstacles.
• Performs well in high pressure or stressful situations.
• Works effectively when direction is unclear or rapidly changing.
• Demonstrates persistence in the face of obstacles.
• Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Responsibilities

• Set up basic contract loads: simple single case agreements (SCAs), basic % of billed charges (BCs), basic % of Medicare, general carve-out codes and basic fee schedule set up.
• Interpret complex contract terms, analyze reimbursement methodologies, and rate structures (e.g., DRG, APC, CPT/HCPCS, ICD-10).
• Load, maintain, and audit client contracts within the adjudication system.
• Validate and test contract configurations for claims pricing accuracy.
• Maintain fee schedule in contract databases and apply annual escalators for client auto renewals.
• Link contracts to payer products, update and maintain provider groups within client databases to ensure seamless claims routing.
• Handles confidential material on a regular basis and is responsible for protecting the confidentiality of such information within the established guidelines of Company and law. (HIPAA Compliance)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level