Medical Bill Review Analyst Jobs (NOW HIRING)

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The Supplier Consultant is accountable for the execution of relevant supply category strategy for a CNA function and supplier management activities including consulting, performance trends, issue management, corrective action plans, and process improvements for all assigned supplier categories. This role will manage suppliers using Performance, Contract, Finance, Risk and Relationship to support a corresponding line of business. Further, this role will oversee top quartile managed care medical bill review, provider network, cost containment operations programs across multiple lines of business. The role will have accountability for coordinating moderate to high complexity business requirements and the sourcing, negotiation, contracting, governance, financial performance, and continuous improvement of new, existing, and potential suppliers. This role will also be accountable for supporting the strategic direction and performance of CNA's medical bill review category, including achievement of medical savings, service quality, operational efficiency, compliance, and customer experience objectives.

JOB DESCRIPTION:

Essential Duties & Responsibilities

Performs a combination of duties in accordance with departmental guidelines:

• Collaborates with business partners to develop and execute supplier category strategies by identifying business requirements, providing market insights, and recommending sourcing approaches to support operational, financial, medical cost management, and business objectives.
• Develops and executes strategies to optimize medical cost containment programs including medical bill review, provider network utilization, fee schedule management, clinical review programs, and ancillary managed care services to achieve quality, financial, and customer outcomes.
• Supports supplier sourcing, selection, negotiation, and contracting activities, including development of RFPs, supplier evaluations, implementation of sourcing strategies, and business case development for new or enhanced supplier solutions.
• Manages supplier relationships utilizing the five pillars of supplier management: Performance, Contract, Finance, Risk, and Relationship.
• Monitors supplier performance to ensure contracted service levels, quality standards, productivity expectations, compliance requirements, financial commitments, and business objectives are achieved.
• Conducts regular supplier performance and stewardship reviews, including analysis of operational, financial, medical savings, network, service, and customer experience metrics to identify trends, risks, and improvement opportunities.
• Leads supplier governance processes including quarterly business reviews, strategic planning sessions, performance remediation activities, and cross-functional stakeholder alignment to ensure suppliers deliver against business objectives.
• Partners with business stakeholders and suppliers to investigate escalated issues, perform root cause analysis, develop corrective action plans, and drive issue resolution.
• Supports continuous improvement initiatives focused on supplier effectiveness, service quality, operational efficiency, cost management, and improved medical cost containment outcomes.
• Provides financial oversight including invoice validation, service credit monitoring, budget forecasting, spend analysis, savings validation, and tracking of supplier savings and performance commitments.
• Identifies and mitigates supplier risks through ongoing monitoring, supplier governance activities, contingency planning, and compliance with applicable regulatory and business requirements.
• Ensures supplier compliance with applicable state and federal regulations, contractual obligations, data privacy requirements, and industry standards related to medical bill review, managed care, provider network, and cost containment operations.
• Maintains knowledge of industry trends, supplier capabilities, emerging technologies, artificial intelligence solutions, automation opportunities, and industry best practices to support business objectives and supplier strategy development.
• Serves as a subject matter resource for assigned supplier categories, including medical bill review.
• Partners with Claims, Finance, Legal, Compliance, Procurement, Data & Analytics, Technology, and other business partners to develop and implement solutions that improve supplier, medical, financial, and operational outcomes.
• Acts as a change agent by influencing suppliers and business partners to adopt process improvements, innovative solutions, and desired business outcomes.

May perform additional duties as assigned.

Reporting Relationship

Director or above

Skills, Knowledge & Abilities

• Strong knowledge of specialty area as well as solid knowledge of departmental sourcing practices and the commercial insurance industry with an in-depth expertise of managed care medical billing products and services.
• Strong knowledge of medical bill review operations.
• Good interpersonal skills and the ability to work independently and with personnel at all levels.
• Ability to prioritize and manage multiple tasks and projects
• Knowledge of Microsoft Office Suite as well as other business-related software.
• Excellent negotiation, verbal and written communication skills.

Education & Experience

• Bachelor's degree or equivalent experience.
• Typically a minimum of five to eight years' work experience in supplier management,
• Experience managing healthcare, managed care, medical bill review, provider network, or cost containment vendors preferred.

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In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $97,000 to $189,000 annually.Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. For a detailed look at CNA's benefits, please visitcnabenefits.com.

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