Job Description

To assist in the negotiation, development, implementation, and maintenance of new and existing professional, facility, and ancillary contracts for the Partnership provider network. The Contract Specialist will also be responsible for supporting daily contracting activities as follows:

Responsibilities

• Negotiate new and existing professional, facility, and ancillary contracts for the Partnership provider network.
• Initiate and negotiate unique Letters of Agreements (LOA).
• Manage provider contracts with clinics, safety net providers, physicians, physician groups, hospitals, free-standing facilities, ancillary, and other provider types for all Partnership programs.
• Effectively communicate Partnership’s mission to help facilitate contracting efforts and ongoing relationship building with the provider community.
• Work with the Director, Provider Relations staff, and other internal Partnership departments to monitor access issues and identify various types of healthcare providers and facilities for contracting opportunities.
• Conduct visits to provider offices as required during the contracting process.
• Assist with obtaining initial contract signatures, contract renewals, and amendments.
• Ensure all contracts and Letters of Agreement are scanned and stored to internal Partnership network drives per department policies and procedures.
• Distribute amendments, new agreements, and LOAs to key departments and staff as appropriate within Partnership.
• Process and respond to requests from external potential providers via phone or written correspondence.
• Respond to general questions regarding the status of contract processing.
• Assist with resolving provider issues involving provider contracts.
• Communicate activities/issues identified during contracting process with Director on a routine basis.
• Fulfill requests for contract copies from internal and external customers.
• Support contract projects and coordinate contracting activities as they relate to Credentialing activities and deadlines.
• Assist with gathering and collating information for all regulatory projects and internal/external audits as required by the Director.
• Assist with tracking and maintaining contracting spreadsheets used for tracking amendments and daily contracting activities.
• Report project and contract status to Director on a routine basis.
• Follow up on outstanding contracting activities via phone or written correspondence.
• Attend internal network planning meetings as directed by Director.
• Answer basic contract questions and assist with provider education as directed.

Secondary Duties and Responsibilities

• Back up to Manager when needed.
• Participate in special projects as assigned.

Qualifications

Education and Experience

Requires a Bachelor’s degree in Healthcare or a related field; and aminimum three (3) years of healthcare experience in managed carepreferably in a provider or payor contracting role or any combinationof education and experience, which would provide an equivalentbackground. Role requires knowledge of health care, managed care,including California Medi-Cal and Medicare contracting using variousreimbursement models including capitation and fee-for-service models.

Special Skills, Licenses and Certifications

Excellent oral and written communication skills. Knowledge of managed care, contracting, policies, and procedures. Requires knowledge of business software applications, specifically MS Excel, Word, Powerpoint. Must be computer proficient. Must have an eye for detail and accuracy.

Performance Based Competencies

Ability to negotiate and build consensus. Excellent organization skillswith ability to prioritize assignments, maintain effective filing andtracking systems, and meet deadlines. Ability to use good judgmentand handle sensitive issues with tact and diplomacy. Ability to applyHIPAA requirements and maintain confidentiality.

Work Environment And Physical Demands

Travel is required. Ability to use a computer keyboard and 10-keycalculator. More than 50% of work time is spent in front of a computermonitor. When required, ability to move, carry, or lift objects ofvarying size, weighing up to 30 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$85,173.51 - $106,466.89

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.