Contract Specialist

CareOregon

1d • Onsite

About The Position

The Contract Specialist negotiates, develops, and maintains provider contracts throughout the state and region which are routine or moderately advanced in nature. This position serves as a resource regarding contract language and terms. This position builds and maintains positive, effective relationships with contracted provider network with attention to ongoing service needs, as well as with internal departments impacted by contract changes. The Contract Specialist identifies expense outliers, performs routine financial analysis, and recommends reimbursement ideas. Area of focus may be Provider Network Contracting or Value Based Contracting.

Requirements

• Minimum 3 years’ experience in health plan or heath care operations, including, some or most of the following: customer service, claims, contracting, provider relations, or network development.
• Knowledge of managed care and the Oregon Health Plan.
• Growing knowledge of federal Medicare regulations and state Medicaid rules (OARs).
• Knowledge of claims administration and ability to implement contract reimbursement terms.
• Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), and ability to perform rate calculations.
• Knowledge of physician group, hospital, and facility operations.
• Strong verbal and written communication skills.
• Word processing, spreadsheet, and database skills.
• Ability to learn and negotiate facility contract language and terms.
• Ability to develop and maintain effective relationships with providers and provider groups.
• Ability to achieve desired outcomes through effective use of negotiation skills.
• Ability to negotiate and implement routine to moderately advanced reimbursement arrangements.
• Ability to develop and maintain professional relationships with internal staff and departments.
• Ability to work with providers, provider groups and other populations in addressing and resolving problems with assistance from management on complex issues.
• Ability to work independently, organize, prioritize, and manage multiple projects.
• Ability to work effectively with diverse individuals and groups.
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions.
• Ability to accept direction and feedback, as well as tolerate and manage stress.
• Ability to see, read, hear, and perform repetitive finger and wrist movement for at least 6 hours/day.
• Ability to speak clearly for at least 3-6 hours/day.

Responsibilities

• Administer the internal contracting process and external network relationships for assigned areas.
• Identify and contact potential providers for inclusion in network, including initiatives pertaining to member access and geographic expansion.
• Coordinate accuracy and maintenance of provider payments with System Coordinators.
• Perform and review routine to moderately advanced financial analysis with Provider Services Director and Finance staff.
• Coordinate accuracy and maintenance of provider payments with Accounts Payable.
• Perform and review routine to moderately advanced financial analysis with Value Based Contracting Manager and Finance staff.
• Learn and integrate federal and state regulations into contract language.
• Negotiate or assist in negotiating contract language and terms.
• Negotiate, coordinate, and produce Letters of Agreement and Memorandums of Understanding.
• Coordinate production and execution of contracts with Provider Services staff.
• Assist in the resolution of provider issues related to contractual relationships.
• Build and maintain effective working relationships with contracted provider network with attention to ongoing service needs.
• Participate in contracting and networking projects; may serve as lead role for small projects.
• Orient CareOregon staff to contracting process; act as a resource to staff on contract-related matters.
• Recommend provider payment and network ideas to contract management.
• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open-mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Benefits

• competitive pay
• bonus opportunity
• medical insurance
• dental insurance
• vision insurance
• life insurance
• AD&D insurance
• disability insurance
• health savings account
• flexible spending account(s)
• lifestyle spending account
• employee assistance program
• wellness program
• discounts
• multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
• strong retirement plan with employer contributions
• PTO accrual
• Paid State Sick Time accrual
• paid holidays
• volunteer time
• jury duty
• bereavement leave
• 401(k) contributions
• other perks

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 11-50 employees