Contract QC Analyst

Job Summary

The Contract Quality Control Analyst supports the Supervisor of Provider Systems & Quality. Performs quality control activities on provider contract and data records that have been entered and processed by the Provider Data and Contracting teams. Ensures the integrity and quality of the provider contract elements, verifying the accuracy of the data and contracting information. Coordinates the internal review and audit process including assisting in monitoring production and quality goals and standards for performance. Identifies process improvements to enhance contracting data and staff quality standards.

Education & Experience

Key Responsibilities

• Maintains all audit tools for internal and external audits.
• Assists in conducting Daily/Weekly/Monthly audits of contract and data staff.
• Monitors accuracy of the provider contract and data by conducting periodic audits.
• Collaborate with multiple business partners including but not limited to Contracting Administration, Corporate Compliance, Claims Administration, and Legal to create strategies for contract templates while being proactive in preventing non-compliance.
• Manages executed contracts and amendments across multiple channels of the healthcare business.
• Develops and monitors quality reports and communications using contracting and provider data management systems.
• Assists in producing trend reports to improve workflow efficiency and system functions to recommend possible solutions to management.
• Assists with resolving data quality issues by identifying, documenting, and communicating quality issues.
• Assists with performing root cause analysis.
• Provides subject matter expertise.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation.

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required.

Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Technical Skills: Healthcare and/or Managed Care experience; working knowledge of Medicare requirements, URAC standards and State and Federal Regulations; working knowledge of the TriWest policies and procedures; current knowledge of Contract Management, Contract Negotiation and Templates, Internal Process Improvement, and medical terminology; knowledge of contracting and provider data management systems; proficient with Word, Excel, and data management systems.

Working Conditions

Taking Care of Our Nation’s Heroes.

It’s Who We Are. It’s What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.