Home » Job Board » CA »
Contracts Specialist, Sr.
Job Description: Contracts Specialist, Sr.
The position contracts with and manages a variety of health care provider contracts and relationships needed to serve CalOptima members. This position will interface directly with a variety of provider types, including individual physicians, physician groups, hospital, and ancillary providers for contracting purposes. The Sr. Contracts Specialist will, implement work with many levels of CalOptima leadership and staff supporting provider contracts and related needs.
• Presents CalOptima and the health plan's provider contracts to interested providers and initiate or facilitate provider credentialing as needed.
• Initiates and manages contracts through to execution.
• Must be able to describe the different CalOptima programs, Managed Care Plan (MCP) County Organized Health System (COHS) Medi-Cal model, government program payment guidelines, and manage on-going MediCal, Dual-Special Needs Plan (D-SNP), Cal MediConnect, and PACE related provider contracts as assigned.
• Effectively communicate with both internal and external customers to help facilitate contracting efforts, and on-going relationship building with Orange County's provider community as needed.
• Collaborates closely with the Managers and Director of Contracting on multiple contracting projects and keeping leadership abreast on progress, issues, and status of new contracts in the Contract Management data base.
• Responds to provider and internal departments regarding questions, and inquiries that relate to contract terms and related policies.
• Works closely with internal departments regarding provider contract obligations and rates.
• Creates, tracks, and monitors status of new contracts in the Contract Management data base.
• Prepares summaries and detailed reports regarding contracted provider network and assigned projects as needed.
• Coordinates and executes Letters of Agreement (LOA) with non-contracted providers under direction from Contracting management.
• Requests and interprets applicable financial data with guidance from CalOptima's Finance and Claims departments to analyze the impact of rate increases or the implementation of other payment methodologies.
• Other projects and duties as assigned.
• Follow CalOptima policies and procedures.
• Comprehend CalOptima’s different government health care programs, how they differ, who they serve, and specific rules and financial terms.
• Understand financial analysis that is related to contract payment terms, program rules, and related impacts to budget and planning.
• Communicate clearly and concisely, both verbally and in writing with internal departments and external customers. Must be able to clearly describe the issues and develop recommendations for consideration.
• Explain CalOptima’s programs and different government health care program payment methodologies.
• Be able to understand contract language, rate schedules, and program policy and procedures.
• Respond appropriately to contracted provider inquires and coordinate resolution with appropriate departments including facilitating warm hand offs.
• Plan and facilitate meetings as needed and prioritize tasks to meet challenging deadlines.
• Work in a fast-paced environment with many changes and many inputs.
• Act as a contracting liaison between the provider and CalOptima.
• Strong written and verbal communication, organizational, prioritization, time management skills.
• Utilize computer and appropriate software (e.g. Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems (e.g. Contract Management) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience & Education:
• Bachelor’s degree required.
• 3 years of experience in the health care field interacting directly with providers required.
• Managed Care contracting experience preferred.
• Have access means of transportation for work away from the primary office approximately 5% of the time.
• Microsoft Outlook, Word, and Excel.
• Other computer applications required to maintain and track provider contracts.
• Managed care contracts and various reimbursement methodologies, health plan delivery models (capitation vs. fee-for-service Medicare, Medi-Cal, commercial plans, etc).
• Guidelines and regulations specific to the health care field.
Job Location: Orange, California, United States
Position Type: Full-Time/Regular
To apply, visit https://apptrkr.com/2036928
Copyright ©2017 Jobelephant.com Inc. All rights reserved.