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Contract Director

2 months ago

Long Beach, United States Ultimate Staffing Full time
Responsibilities and Duties

  • Lead the Payer and Provider Contracting department.
  • Collaborate with the Contract Manager to analyze contracting needs, including the review of claims and utilization data, to identify opportunities for new and renegotiated contracts.
  • Manage contracting and negotiations for various reimbursement models, including fee-for-service, capitation, and value-based models, across health plans, hospitals, ancillary service providers, and physician specialties.
  • Recruit, develop, and maintain contracted provider networks, ensuring that negotiated contracts meet network needs.
  • Review contract implementation to ensure accurate and appropriate administration.
  • Foster and maintain strong, cost-effective, and mutually beneficial relationships with key providers and clients.
  • Ensure timely administration and implementation of contract terms.
  • Serve as a technical resource for contract-related issues.
  • Maintain an internal contract database to manage accurate data and comprehensive contract details.
  • Advise other departments of new contracts and amendments, updating internal systems and processes as needed.
  • Research, analyze, and resolve complex issues related to hospital shared risk pools, claims, appeals, authorizations, and eligibility, ensuring compliance with contract terms and timely resolution.
  • Handle patient protected health information (PHI) in accordance with HIPAA standards.
  • Oversee the process for managing letters of intent (LOIs) from prospective providers.
  • Assist with health plan documents and Division of Financial Responsibility (DOFR) as needed.
  • Maintain and update contract templates and amendments, ensuring compliance with state and federal laws, internal operations, and financial requirements.
  • Represent the department in internal and external audits.
  • Continuously seek opportunities to improve functional processes and business efficiency.
  • Participate in Joint Operations Committee (JOC) meetings and interdepartmental meetings, and substitute for Contract Negotiators when necessary.
  • Hire, manage, train, and evaluate staff, setting goals and expectations for performance.
  • Coordinate administrative functions for leadership and department staff, ensuring responsiveness to internal and external customer needs.
  • Create processes and documentation, including notices, memos, and drafts of policies and procedures as appropriate.
  • Perform other duties as assigned.

Education and Experience Requirements

  • Bachelor's Degree in Health Care Administration, Public Health, Business, or a related field is required; Master's Degree preferred.
  • A minimum of 5 years of recent experience in healthcare contracting.
  • Experience with Health Maintenance Organizations (HMO), Medicare Advantage (MA), or Independent Physician Associations/Management Service Organizations (IPA/MSO).
  • Demonstrated expertise in planning, preparation, and presentation, with a deep understanding of reimbursement and bonus methodologies.
  • Comprehensive knowledge of Medicare policies, procedures, and processes.
  • Proficiency in computer skills, including word processing, spreadsheets, database management, Outlook, and EZCAP.
  • Excellent verbal and written communication skills.
  • Strong ability to prioritize and multitask while maintaining attention to detail.
  • Ability to work effectively in a fast-paced environment and adapt to changes quickly.
  • Strong analytical and problem-solving abilities.
  • Ability to meet deadlines consistently.
  • Strategic thinker with a focus on process improvement.
  • Demonstrates professionalism, ethical conduct, and sound judgment at all times.
  • Willingness to travel as required.
Desired Skills and Experience

This position is only open to Hybrid schedules in the greater Southern California area - not open to fully remote at this time.

The Contract Director is responsible for leading the contracting department and supporting the management of Client Provider Networks. This includes working with contracted health plans, primary care physicians, specialists, key hospitals, ancillary providers, and other necessary partners to help the Client Network achieve its goals, such as maintaining a healthy population, controlling costs, and achieving high-quality standards. The Contract Director reports to the Senior Vice President of Contracting.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance. To the extent our customers require a background check for certain positions, the Company faces a significant risk to its business operations and business reputation unless a review of criminal history is conducted for those specific job positions.