Contract Specialist, Provider

Altais

About The Position

The Contracts Specialist, Provider is responsible for managing and supporting provider contracts for all lines of business; Commercial, Medicare and Medi-Cal HMO and PPO for multiple medical groups and Independent Physician Associations throughout California. Primary duties include drafting provider contract agreements and amendments, Letter of Agreement negotiation and analyses, contract terminations, contract file integrity in contract management system, ancillary grid maintenance, and contributing to operational implementation of all provider agreements. You will focus on: Collaborate with Contracting Department, internal and external stakeholders to support the successful execution of departmental and company goals. Responsible for complex provider inquiries and/or problems related to operations, contract interpretation (e.g DOFR, delegation), claims, and facilitates resolution. Continuously strives to ensure that favorable relationships are maintained while ensuring the interest of the company. Liaison between providers and internal departments which include but are not limited to management, finance, medical services, claims, configuration, network management, customer service, legal, compliance and other internal departments. Assist with the planning and scheduling of routine payer joint operations committee meetings with large provider groups and hospitals which may include various internal and external leaders. Responsible for developing and/or improving provider contracting existing tools, resources, contract language, physician education resource materials, job aides, policies and procedures (e.g. contracting workflows, value-based contracts, physician resources for billing). Manage and participate in the development and implementation of systems (e.g. Symplr/sPayer, Epic) that support network operations and network management to encourage standardization, best practices, and maximize functionality (e.g. automation, report writing, workflows). Manage departmental intranet webpages; updating content with tools and resources, ensuring information is continuously up to date and accurate. Develop and manage Contracting communications including distribution of fully executed contracts to ensure accurate and timely configuration of contract terms in Epic system. Contract Management and Maintenance; routing documents for signature, tracking necessary signatures, uploading contracts into database (e.g. Symplr/sPayer). With limited supervision, effectively supports provider negotiations to achieve contracting strategy and attain budgeted results on a timely basis. Responsible for analyzing data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues. Collaborates with internal stakeholders to develop provider value-based contracts. Drives change and innovation through continually seeking and implementing value added solutions to ensure company goals are met. Effectively communicate and advocate providers' needs to internal stakeholders to drive creation of solutions that meet our mutual business goals. Understands provider relationships within market and ensures any operational issues are visible to the appropriate parties and work towards a reasonable resolution. Assist in the preparation and review of contract documentation by checking for accuracy and analyzing contract terms and history. Research, gather, and organize provider contracts for audits, projects, and negotiations. Participates in ongoing departmental staff cross-training to provide continuous departmental improvement. Completes projects within scheduled time frames and within established standards. Solicits information and feedback from operating departments regarding, implementation and performance of contracts as required. Administers and creates documents and mailings to providers, as well as contract related mailings. Travel may be required, as determined by business need.

Requirements

College degree or equivalent experience
Minimum 3 -5 years’ experience in Managed Care provider network, required
Basic financial analysis experience, required
Minimum of 2 years of contracting or physician relations experience in responsible positions in health care contracting required

Nice To Haves

External hires must pass a background check/drug screen.

Responsibilities

Drafting provider contract agreements and amendments
Letter of Agreement negotiation and analyses
Contract terminations
Contract file integrity in contract management system
Ancillary grid maintenance
Contributing to operational implementation of all provider agreements
Collaborate with Contracting Department, internal and external stakeholders to support the successful execution of departmental and company goals
Responsible for complex provider inquiries and/or problems related to operations, contract interpretation (e.g DOFR, delegation), claims, and facilitates resolution
Liaison between providers and internal departments
Assist with the planning and scheduling of routine payer joint operations committee meetings
Developing and/or improving provider contracting existing tools, resources, contract language, physician education resource materials, job aides, policies and procedures
Manage and participate in the development and implementation of systems (e.g. Symplr/sPayer, Epic) that support network operations and network management
Manage departmental intranet webpages
Develop and manage Contracting communications including distribution of fully executed contracts
Contract Management and Maintenance; routing documents for signature, tracking necessary signatures, uploading contracts into database (e.g. Symplr/sPayer)
Supports provider negotiations to achieve contracting strategy and attain budgeted results on a timely basis
Analyzing data while collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
Collaborates with internal stakeholders to develop provider value-based contracts
Drives change and innovation through continually seeking and implementing value added solutions to ensure company goals are met
Effectively communicate and advocate providers' needs to internal stakeholders to drive creation of solutions that meet our mutual business goals
Ensures any operational issues are visible to the appropriate parties and work towards a reasonable resolution
Assist in the preparation and review of contract documentation by checking for accuracy and analyzing contract terms and history
Research, gather, and organize provider contracts for audits, projects, and negotiations
Participates in ongoing departmental staff cross-training to provide continuous departmental improvement
Completes projects within scheduled time frames and within established standards
Solicits information and feedback from operating departments regarding, implementation and performance of contracts as required
Administers and creates documents and mailings to providers, as well as contract related mailings