Provider Contracting Specialist

4 weeks ago


San Jose, California, United States Santa Clara Family Health Plan Full time
Job Description

The Provider Contracting Manager plays a pivotal role in the day-to-day handling of Santa Clara Family Health Plan's provider agreements, ensuring compliance with state and federal regulations. This position requires the ability to negotiate and implement provider agreements, coordinate financial analyses, and participate in Contracting Committee meetings.

Key Responsibilities
  • Apply state and federal regulations, and Health Plan operational processes to negotiate and implement provider agreements.
  • Coordinate the financial analyses of contracts, and actively participate in Contracting Committee meetings.
  • Meet and confer with providers, health plans, third party vendors, and other customers.
Requirements
  • Bachelor's Degree in Healthcare Administration, Business, or a related field.
  • Minimum four years of experience in managed care or in a healthcare setting in positions requiring routine interaction with internal and external stakeholders.
  • Working knowledge of various contracting methodologies for Medi-Cal and Medicare, including fee for service arrangements, capitated agreements and alternative payment methodologies.
Working Conditions

General office conditions. May be exposed to moderate noise levels.


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