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Health Care & Hospital Operations

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Contract Operations Analyst

Location: Oakland, CA Job Number: 723489 Date posted: 08/07/2018
Description: Supports the contracting function of the Community Medical Services Department. Conducts data and systems analyses to support the business functions of Community Medical Services.

Essential Functions:
  • Analyzes and interprets contract provisions for entry into the system to ensure accurate adjudication of claims. Advises Senior Contract Consultants of impact of various payment methodologies throughout adjudication systems.
  • Works with Claims Administration Department to ensure operational feasibility. Sets up contract templates for entering into the system. Enters systems records into the system for automating contracts.
  • Oversees contract document management, including production, analysis, and tracking of documents.
  • Represents Community Medical Services on various committees and task forces. Evaluates proposed systems expansions, enhancements, and design changes. Coordinates implementation of approved changes. Participates in development of performance indicator reports.
  • Monitors and analyzes indicators. Identifies and helps resolve performance problems. Provides staff support to CMS/CAD Management Council.
  • Serves as liaison between CMS, CAD, IT, local Kaiser medical center, and contracted medical provider.
  • Provides training and education on understanding and using data from the system. Serves as Division-wide resource for issues and questions regarding contract and claims payment data.
  • Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.

  • Basic Qualifications:
    Experience
  • Minimum three (3) yearsof experience in health care with experience in a billing/payment environment.
    Education
  • Bachelor's degree in health care, business administration or related field OR four (4) yearsof experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.
    License, Certification, Registration
  • N/A

    Additional Requirements:
  • Extensive knowledge of health care delivery systems, with particular emphasis on billing for medical services and payment methodologies, physician and hospital coding practices.
  • Working knowledge of medical terminology and relevant governmental regulations pertaining to HMOs and to Medicare.
  • Demonstrated experience in the ability to effectively communicate both verbally and in writing with parties who may have conflicting interests and different interpretation.
  • Skill in conflict resolution and meeting facilitation.
  • Demonstrated ability to work independently, make decisions when appropriate and know when to ask for input from others.
  • Must be able to work in a Labor/Management Partnership environment.

    Preferred Qualifications:
  • Experience from the payer perspective strongly preferred.
  • Experience in mainframe computer system development, application and maintenance from a user perspective.
    Primary Location: California,Oakland,1950 Franklin 1950 Franklin Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 9:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Non-Union, Non-Exempt Job Level: Entry Level Job Category: Healthcare / Hospital Operations Department: Regional Medical Services Contracting Travel: No
    Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
  • About Health Care & Hospital Operations Careers

    Health Care & Hospital Operations Careers

    Envision the future, inspire change, and deliver results. Put your talents to work not just at a powerful business, but at an organization dedicated to empowering the health and well-being of millions. As a valued member of the Kaiser Permanente team, your visionary and strategic contributions are especially vital to our success. Come drive change within the organization and across the future of health care.

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