Contract Compliance Analyst III

Position Overview: Contract Compliance Analyst III

At Exact Sciences, we are dedicated to transforming how the world prevents, detects, and guides treatment for cancer, providing crucial clarity for confident decisions. Join our purpose-driven team where an inclusive culture and robust benefits support your life while you help others.

The Contract Compliance Analyst III will play a critical role in facilitating contract implementation and revenue pull-through activities, both proactively and reactively, with internal and external parties. This position ensures public and private payer reimbursement and is fundamental in reviewing that billing and payment processes are efficient, timely, and in compliance with corporate goals, contracts, and regulations. You will facilitate and manage contract implementation for operations and partner with Managed Care to develop and maintain agreements that provide medical providers and patients with access to our assays while aligning with Exact Sciences' objectives.

This is a remote position; candidates must reside in the state of Wisconsin.

Essential Duties

• Develop communication for contracts, amendments, and notifications for the internal Revenue Cycle Team (RCT) customers.
• Collaborate with the Field Managed Care team in negotiations with payers for operational optimization.
• Play a key role in the development and maintenance of a contract database and contract management system, working with credentialing and legal teams.
• Collaborate with finance and analytics to identify, analyze, and determine next steps to address negative revenue pull-through scenarios specific to payers (e.g., Medicare Advantage, Blues, Medicaid).
• Collaborate with RCT Managers and specialists to develop and leverage relationships with billing operations staff and payers for resolving claim adjudication issues.
• Support the execution of pull-through plans to meet quarterly and annual revenue recovery goals.
• Identify broad revenue opportunities spanning customer segments, utilizing Content Management Systems (CMS) for non-contracted Managed Medicare non-payments and the Employer Coalition initiative.
• Consistently identify opportunities to recover revenue.
• Collaborate with the Managed Care team to identify and prioritize plans utilizing key payers for targeted efforts to impact coverage policy decisions.
• Facilitate conversations with appropriate Exact Sciences personnel early in the contracting process to provide an overview of the account and prevent implementation delays.
• Demonstrate strong attention to detail and organizational skills.
• Apply strong analytical skills.
• Drive to results with a high emphasis on quality.
• Present recommendations supported by analytical evaluations.
• Prioritize and multi-task effectively.
• Integrate and apply feedback in a professional manner.
• Exhibit excellent written and verbal communication across internal and external personnel.
• Collaborate and work effectively as a team member.
• Uphold company mission and values through accountability, innovation, integrity, quality, and teamwork.
• Support and comply with the Quality Management System team’s policies and procedures.
• Maintain regular and reliable attendance.
• Act with an inclusion mindset and model these behaviors for the organization.

Minimum Qualifications

• 3+ years of experience in billing/reimbursement, coverage, claims, and appeals.
• Demonstrated understanding of public and private Managed Care payers and the reimbursement process.
• Demonstrated understanding of market-related issues, contract basics, product coverage, and pull-through rationale.
• Proficient with Excel and Epic or similar database, with a demonstrated ability to maintain competency levels.
• Applicants must be currently authorized to work in the country where work will be performed on a full or part-time basis.

Preferred Qualifications

• Knowledge of and/or experience with government Managed Care payers.
• Knowledge of billing and coding.

Key skills/competency

• Contract Compliance
• Revenue Cycle Management
• Payer Reimbursement
• Managed Care
• Financial Analysis
• Data Analysis
• Billing Operations
• Claims Adjudication
• Contract Management Systems
• Communication Skills