Contracting Specialist

WVU Medicine

22h

About The Position

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Plays a critical role in developing a network for our members and providers. Reporting to the Manager of Contracting you will be a critical part of the Provider Relations team. The ideal candidate for this role is a passionate, community oriented and has direct health plan managed care contracting experience. You have strength in negotiating complex contacts, evaluating competing priorities while staying aligned with organizational goals and strategies. You are technically savvy with a solid understanding of network adequacy requirements and health plan analytics to aid in the contracting process. You are flexible and thrive in a fast-paced, environment. The Contracting Specialist is responsible for analyzing contracts between Peak Health and its network providers for the various Peak Health products. Analyze data from various sources and systems for both physician and hospital services in order to present reports to key management and staff and to recommend and implement solutions to assist in the contracting decision-making process.

Requirements

Bachelor’s degree in Business Administration, Health Care Management OR High School Diploma and equivalent AND Two (2) years contractual or financial related experience.
One (1) year of work experience in healthcare data analytics, healthcare consulting analytics or healthcare contracting analytics.
One (1) year of related healthcare insurance experience in related contractual, financial or provider related activities with major healthcare insurance companies.
Thorough understanding of healthcare regulations.
Ability to perform contract modeling.
Understanding of healthcare reimbursement payment methodologies.
Strong problem solving and quantitative abilities.
Excellent communication and collaboration skills.
Attention to detail.

Nice To Haves

Direct experience in data analysis, financial analysis and reporting to include proficient extracting information from various payer systems; utilizing information obtained in most applicable manner; and developing complex mathematical models.
Progressive experience in health care management, physician groups, hospitals, payer contract negotiations, legal reviews of contract, or contact management.
Consulting and/or healthcare decision support work experience in the healthcare industry.

Responsibilities

Conducts negotiations with hospitals, physicians and ancillary providers on behalf of Peak Health.
Presents healthcare data in a meaningful, concise and beneficial manner to upper management.
Utilizes data to provide consulting service and decision support on healthcare topics critical to health plan system wide decisions for upper management.
Develops and maintains tracking system for reimbursement and statistical information. Ensures data integrity and accuracy.
Summarizes offers for review with appropriate Peak Health committees and individuals.
Communicates the implementation of new and renewal contracts to upper management and monitors the reimbursement to ensure accurate payment of claims by Peak Health.
Audits large volumes of data and conducts in-depth quantitative analysis of results and evaluates trends.
Communicates and educates other regarding financial improvement analysis, findings and recommendations.
Maintains contract files for Peak Health.
Maintains physician fee and hospital rate information for Peak Health contracted providers.
Maintains contract information on major providers with selected competitor and benchmark providers.
Organizes meeting materials and attends various organization meetings as needed as well as assists in development of annual strategic planning.
Works with providers to resolve provider billing, denial, and appeal issues and explores hassle reduction improvements to incorporate into new and existing contracts.
Must remain current with how information is collected, maintained and reported in all key systems.
Participates in meeting the objectives of the work unit and goal of the department.