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Contract Specialist 2
3 months ago
Department:
HA - Prov Contract&Fin Anlysis
Job Category:
Professional
Employment Type:
Full - TimeJob ID: 42827
Experience Required: - 5 Years
Education Required:
Not IndicatedShift: DayLocation: Remote
Usual Schedule:
Mon-Fri 8-5
On Call Requirements:
No
Work Location:
HA Working from Home
Holiday Requirements:
NoEmail a Friend Save Save Apply Now
Position Summary:
Responsible for initial contract negotiations and renewals with hospitals, PHOs, IPAs, large group practices and select ancillary providers; financial management and analysis of provider contracts; produce timely contracts within predetermined medical trend guidelines
Qualifications:
EDUCATIONAL REQUIREMENTS Bachelors Business or Additional four (4) years experience in managed care contracting may be a substitute for education requirements.
Four (4) years experience in managed care contracting or healthcare contracting, or four years related progressive administrative experience in provider office, legal setting with a minimum of two (2) years experience in health care or managed care contracting.
SKILLS AND KNOWLEDGE Demonstrated proficiency in Word, Excel, database software required.Must project a professional image while interacting with a variety of personalities in person, over the telephone or via electronic mail.
Must be a skilled negotiator with strong problem solving skills. Must be skilled negotiator and adept at persuasion. Must have familiarity with medical terminology. Must be familiar with Medicare-based payment methodologies, standard coding and managed care terminology. Must work independently and possess strong problem solving and analytical skills. Must have excellent oral and written communication skills and be able to make effective group presentations. Must be able to explain and justify legal documents and language. Must have exposure to financial analysis and proposals and conduct complex financial modeling. Must have experience with and a thorough understanding of contracts, legal documents and legal terminology. Must be highly organized and able to prioritize multiple tasks to achieve goals. Must follow predetermined time lines for completion of tasks.Must be proactive in presenting solutions to complex provider issues. Must be able to apply past knowledge to new situations.
Ability to do both internal and external research related to provider status and reimbursements in order to prepare for network development and contracting.
Essential Functions:
Develops financial proposals, evaluates and monitors contract performance and prepares financial analysis and recommendations.
Ensures that all contracts are in compliance with regulatory requirements.
Ensures that all negotiated contract terms follow Health Alliance's standards and can be successfully implemented in the claims payment system.
Manages overall contracting process with providers including preparation of documents, negotiation, follow-up, and documentation of activities in contract management system.
Plans proactively for all contract renewals including financial analysis and potential reimbursement changes; completes renewal process.We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.
| For more information:September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.#J-18808-Ljbffr
