Join the World's Top Legal Talent Network

Join us as we work to create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.

The team: This role is part of the Emerging Product Services team, which incubates new products and services by designing optimal enablement pathways, providing customer support, developing training collateral, and surfacing gaps to Product, ensuring that new offerings are stable and at scale before going to market. This team provides support for our emerging products and services, by responding to internal and external stakeholders, troubleshooting complex issues, executing on defined product deliverables, and providing timely resolutions.

The role: the Contract Management Associate will work with athenahealth’s contract management team to build innovative solutions for practices to get paid per their payer contracts. These solutions will help unlock key business outcomes such as accurate provider & practice payments, accurate patient liability estimation.

Experience & Skillset

• Experience working with payer contracts in the US healthcare system for ambulatory practices – this includes government payer (Medicare, Medicaid) contracts as well as commercial payer contracts
• Proven ability to interpret complex legal language and contract terms Hands-on experience with payer contract creation/analysis & management.
• Experience analyzing negotiated contracts containing contract-level terms with the ability to translate contractual terms.
• Knowledge of payer policies, practice organizational structures and contract implications
• Good understanding of types of contract documents, contract structures, fee Schedules and payer specific formatting.
• Functioning knowledge of DRG, CPT, HCPCS, ICD-9, ICD-10, and APC codes and logic behind reimbursement of each
• Understanding of complex managed care concepts and reimbursement methodologies in US healthcare (Prospective payment systems, case rate billing, capitation contracts, value-based reimbursement) Understanding of healthcare transactions (eligibility 270/271 and EOB/ERA 835) and ability to map to payer contract data
• Knowledge of insurance submittal procedures and medical forms (including UB04 and CMS1500)
• Thorough understanding of US healthcare regulations and compliance with experience in monitoring updates to these regulations
• Possess strong analytical, communication, collaboration and organizational skills
• Strong proficiency in Microsoft Office applications, particularly Excel, for data analysis and manipulation
• Strong problem-solving and critical thinking skills

Responsibilities

• This role will be an individual contributor - a self-starter who is detail oriented and organized.
• The payer contract analyst will partner with the contract management team on ensuring that the right solutions are built for reporting variances and estimating patient liability.
• Able to handle complex & large datasets to conduct analysis on payment mismatch trends to enable identification of root causes for underpayments
• Partner with product management on contract data discovery and payer relationships
• Periodically monitor and report updates to governmental regulations & commercial payer policies that impact reimbursement
• Serve as the specialist helping internal stakeholders interpret contract language
• Synthesize large amounts of complex information into clear outcome statements
• Load contracts as required and keep up-to date with amendments and addendums. Ensure contract loading is accurate with proper interpretation and build out of payers’ contract terms, policies and pricing logic.
• Recommend changes to optimize contract performance. Identify and report on areas of practice operations including billing and coding practices that affect contractual reimbursement.

Qualifications

• Bachelor’s degree in health informatics, accounting, finance, business administration or related field required.
• At least 4 years of experience in provider/payer relations, contract negotiations and/or claims billing required
• At least two years' working directly with managed care contracts or equivalent Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification preferred

About Athenahealth

Here’s our vision: To create a thriving ecosystem that delivers accessible, high-quality, and sustainable healthcare for all.

What’s unique about our locations?

From an historic, 19th century arsenal to a converted, landmark power plant, all of athenahealth’s offices were carefully chosen to represent our innovative spirit and promote the most positive and productive work environment for our teams. Our 10 offices across the United States and India — plus numerous remote employees — all work to modernize the healthcare experience, together.

Our Company Culture Might Be Our Best Feature.

We don't take ourselves too seriously. But our work? That’s another story. athenahealth develops and implements products and services that support US healthcare: It’s our chance to create healthier futures for ourselves, for our family and friends, for everyone.

Our vibrant and talented employees — or athenistas, as we call ourselves — spark the innovation and passion needed to accomplish our goal. We continue to expand our workforce with amazing people who bring diverse backgrounds, experiences, and perspectives at every level, and foster an environment where every athenista feels comfortable bringing their best selves to work.

Our size makes a difference, too: We are small enough that your individual contributions will stand out — but large enough to grow your career with our resources and established business stability.

Giving back is integral to our culture. Our athenaGives platform strives to support food security, expand access to high-quality healthcare for all, and support STEM education to develop providers and technologists who will provide access to high-quality healthcare for all in the future. As part of the evolution of athenahealth’s Corporate Social Responsibility (CSR) program, we’ve selected nonprofit partners that align with our purpose and let us foster long-term partnerships for charitable giving, employee volunteerism, insight sharing, collaboration, and cross-team engagement. __

What can we do for you?

Along with health and financial benefits, athenistas enjoy perks specific to each location, including commuter support, employee assistance programs, tuition assistance, employee resource groups, and collaborative workspaces — some offices even welcome dogs.

In addition to our traditional benefits and perks, we sponsor events throughout the year, including book clubs, external speakers, and hackathons. And we provide athenistas with a company culture based on learning, the support of an engaged team, and an inclusive environment where all employees are valued.

We also encourage a better work-life balance for athenistas with our flexibility. While we know in-office collaboration is critical to our vision, we recognize that not all work needs to be done within an office environment, full-time. With consistent communication and digital collaboration tools, athenahealth enables employees to find a balance that feels fulfilling and productive for each individual situation.

athenahealth is committed to a policy of equal employment opportunity—that’s why we recruit and hire applicants without regard to race, color, religion, sex (including pregnancy), national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. We’re happy to provide a reasonable accommodation, for those with a disability, to complete any part of the application process. If you are unable to access or use this online application process and need an alternative method for applying, please contact us at taoperations@athenahealth.com for assistance.

https://www.athenahealth.com/careers/equal-opportunity