Contract Negotiator

4 days ago

Orange, California, United States Alta Hospitals Full time
Job Summary

Alta Hospitals is seeking a highly skilled Contract Negotiator to join our team. As a Contract Negotiator, you will play a critical role in developing and managing the contracting process, analyzing and negotiating agreements/contracts to meet the financial objectives of the company.

Key Responsibilities
  • Contract Negotiation: Evaluate and conduct health plan, hospital-to-hospital, and ancillary services contract negotiations to ensure timely completion, purpose, accuracy, and profitability of reimbursement structure.
  • Managed Care Contracting: Negotiates competitive managed care health plan contracts, management services agreements, ancillary agreements, letters of agreements, and other managed care contract types as assigned.
  • Contract Management: Negotiates and processes ad hoc and out-of-network health service requests, per policy, on a regular and time-sensitive basis; works with medical management to secure a competitive financial arrangement for capitated members care.
  • Regulatory Compliance: Understands and adheres to all Federal and State Medicare/Medicaid timeliness regulations. Maintains confidentiality in accordance with hospital policies and HIPAA privacy regulations.
  • Contract Analysis: Maintains a comprehensive understanding of managed care contracting, finance, hospital operations, and negotiation of complex reimbursement methodologies, including; capitation and fee-for-service arrangements for Medi-Cal, Medicare, Covered CA, and Cal Medi-Connect.
  • Contract Review: Prepares and reviews redlined contract changes and recommends contract language to assure compliance with legal requirements and business objectives.
  • Relationship Management: Manages contractual relationships with recuperative care and other SDOH agencies to assist with discharge planning and access to alternative support systems as needed.
  • Contract Administration: Manages contract documents with internal and external parties to successfully implement managed care contracts, including but not limited to the creation and maintenance of any required databases necessary to conduct an organized and efficient logging system.
Requirements
  • Education: A bachelors degree is required. Masters Degree preferred.
  • Experience: Five (5) years of experience in a managed care organization, such as a hospital system, MSO or Health Plan required.
  • Skills: Excellent computer literacy and proficiency MS Office Suite ability to navigate the Teams environment proficiently required. Significant understanding and experience with hospital contracting in a Managed Care Risk, Medi-Cal, and Medicare environment.
  • Personal Qualities: Demonstrates excellent organizational skills/abilities and ability to work independently in a completely remote environment. Ability to work in an environment where there are multiple priorities and deadlines which change frequently. Ability to establish and maintain effective working relationships across the organization.

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