Contracting Specialist

Astrana Health, Inc.•Orange, CA

5d•$26 - $33•Hybrid

About The Position

Astrana Health is looking for a Contracting Specialist. This role will report to our Director - Provider Contracting Operations and enable us to continue to scale in the healthcare industry.

Requirements

Proven ability to prioritize and organize while ensuring attention to detail
Work independently to ensure established turn around times and project deadlines are met
Proficient in Microsoft Office Suite
Working knowledge of DOFRs, Claims, Utilization Management, Network Management, Eligibility, CPT Coding, Diagnosis Coding and Medical Terminology
Strong communication, critical thinking, problem resolution, and interpersonal skills
Ability to read, comprehend, and interpret managed care contractual agreements
Three years contract negotiations in a managed care environment working with Medicare and Medicaid fee schedules
Maintain confidentiality and adhere to all regulatory requirements as well as to policies and procedures
Associates degree or equivalent education and experience

Nice To Haves

You have knowledge of Commercial, Medicare, Medicaid lines of business

Responsibilities

Supports contracting efforts and loading for provider contracts
Negotiate Patient Specific MOUs
Process, Load, and maintain contracts and providers in contracting database application
Acts as liaison with various internal departments to facilitate and resolve claims, provider configuration, customer service, credentialing, and other related issues.
Negotiate and draft LOA/MOU agreements outlining contractual terms as directed
Draft provider terminations and other provider correspondences
Initiate changes to internal departments for updates, health plan submissions, and member outreach as needed
Load agreements and providers to contracting data application with all contractual terms and linkages
Manage Inquiries email box and Referral Queue
Provide clarification on contractual arrangements to internal departments, providers and billing companies
Provides customer service to network providers and other internal departments by responding to contracting inquiries, claims questions, and credentialing inquiries, and provider configuration
Problem solve inquiries regarding contract or provider set up
Works with credentialing department as needed to obtain credentialing and re-credentialing documents
Track and document tasks to completion
Generate reports as requested
Other duties as assigned