Skill required: Provider Network - Life Sciences Regulatory Operations
Designation: Health Operations Senior Analyst
Qualifications:Any Graduation
Years of Experience:5 to 8 years
About Accenture
Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 784,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com
What would you do? Embedding digital transformation in healthcare operations end-to-end, driving superior outcomes and value realization today, and enabling streamlined operations to serve the emerging health care market of tomorrow A Provider Network is a group of healthcare professionals and facilities, such as doctors, hospitals, and clinics, that are contracted to provide medical services to members of a health insurance plan. The goal is to offer a range of healthcare options to insured individuals at negotiated rates. Members typically receive better coverage and lower costs when they use providers within the network. It ensures access to quality care while managing healthcare expenses. Effective provider networks are crucial for the efficient delivery of healthcare services. Coordinate the essential documentation and resources required for the filing of global applications. Understand, manage & process electronic submissions that include original application filings, Life Cycle Management submissions such as CMC, Ad-promos, amendments, annual reports, SPL submissions, etc.
What are we looking for? •Adaptable and flexible •Problem-solving skills •Results orientation •Written and verbal communication •Strong analytical skills The Contract Configuration Analyst is responsible for the accurate build, maintenance, and quality assurance of provider contracts within Epic Tapestry and associated health systems in support of provider administration operations. This role plays a critical part in ensuring contractual intent is correctly translated into system configuration, enabling accurate claims adjudication, compliance with contractual and regulatory requirements, and adherence to service level agreements. The analyst works closely with health plan Contract Managers, Provider Demographics teams, Pricing, Claims Operations, and Quality Audit and Testing teams to execute contract configuration work while maintaining high quality, turnaround time, and audit readiness. Key Responsibilities: • This process involves understanding and interpreting the legal contract agreement, and translating the compensation terms into contract configuration components into Epic Tapestry. This includes setting up vendor contracts, pricing, and adjudication, as well as conducting contract configuration claim testing. • Configuring and maintaining provider contracts, fee schedules, and related configuration elements based on approved contract language and Customer standards. • Performing configuration activities in alignment with documented procedures, training materials, and governance controls. • Handle complex or non-standard contract configurations, including exception scenarios requiring interpretation beyond standard procedures. • Participating in quality reviews, audits, and defect remediation activities as required to meet applicable Service Levels. • Identifying configuration issues and escalating items requiring clarification or exception handling through defined governance channels. • Identify opportunities for process improvements, standardization, or automation to enhance efficiency and reduce defects. • Supporting service ramp up, transition, and knowledge transfer activities as requested.
Roles and Responsibilities: •In this role you are required to do analysis and solving of increasingly complex problems • Your day to day interactions are with peers within Accenture • You are likely to have some interaction with clients and/or Accenture management • You will be given minimal instruction on daily work/tasks and a moderate level of instruction on new assignments • Decisions that are made by you impact your own work and may impact the work of others • In this role you would be an individual contributor and/or oversee a small work effort and/or team • Please note that this role may require you to work in rotational shifts • •• Strong understanding of US healthcare provider contracting, including professional, facility, and fee schedule structures. • 3-5+ years of experience in US healthcare payer operations with hands-on Epic Tapestry contract configuration experience. • Proven ability to interpret complex contract language and translate it into precise system configuration. • Experience supporting claims pricing, adjudication, and pended claim resolution as it relates to contract configuration. • Able to work independently with analytical mindset focused on problem-solving. • Exceptional attention to detail with the ability to independently identify configuration gaps or inconsistencies. • Proactive escalation and issue management mindset to protect effective dates and client outcomes • Epic Tapestry Certification or Accreditation • Demonstrates strong communication skills, effectively articulating identified issues, proactively escalating concerns, and proposing solution-oriented recommendations.
Any Graduation
