Contracts Associate - SCMG Capitation Administration - Sharp Corporate - Day Shift - Full Time

Sharp HealthCare•San Diego, CA

3d•$40 - $57

About The Position

The Contracts Associate assists with the operations, negotiations and analyses of contracts, capitations and ongoing relationships with providers. Oversees the administration and production of provider contracts by negotiating Letters of Agreement with non-contracted providers; auditing IDX claims system to verify appropriate and correct reimbursement; liaison with claims support department on new contracts and contract changes. Participates in SCMG strategy and support through contract and claims data analysis. Responsible for operational support system response to contract informational needs and monitor physician issues regarding contracting priorities.

Requirements

4 Years experience in Managed Care contracting.
Experience in a health related or contract negotiation environment.
Experience in maintaining positive working relationships with Physician and Provider representatives.
Must have experience with analyzing, interpreting data, and preparing reports.
Associate's degree in Accounting, Finance, Business Administration, Health Care Administration; experience may substitute for education.

Nice To Haves

Knowledge of Managed Care and Managed Care Contracts, experience in PC computer utilization for word processing and Excel spreadsheet analysis, and managerial skills is required.
Working knowledge of Managed Care capitation, RBPVS/CPT/ICD-10 coding.

Responsibilities

Contract administration Responsible for requesting, preparing and analyzing data necessary for contract negotiations.
Develop reports necessary to determine contract performance compared to budget and established standards.
Conducts and participates in the successful completion of assigned contract negotiations as they relate to SCMG contracts.
Assist in the development and maintenance of communication links throughout the system to identify reimbursement issues and participation in the development of action items for resolution.
In addition, communicate current contract information.
Assures contract information is communicated and coordinated to appropriate internal departments and audit is performed to ensure accurate contract claim/encounter pricing and other reimbursement terms.
Work in conjunction with system representatives in the implementation of the IDX Contract Adjudication system.
Assists with other duties as assigned, to be completed in an agreed upon format in an agreed upon time frame.
Demonstrates teamwork by participating in achieving department goals.
Shows willingness to help out with any task to ensure the success of the department.
Works in a spirit of cooperation with all Sharp employees.
Quality and customer service Provide operational support to internal and external customers.
Assist in project coordination with SCMG departments: Claims, Utilization Management, Provider Services, and Pharmacy Benefits Department.
Maintains service orientation to representatives of SCMG through consistent assessment of needs and timely response to requests.
Develops and maintains relationships with Physician and Provider contract representatives in support of the SCMG Mission, Values, and Philosophy and ensure timely response to contractual issues and contract compliance problems.
Collaborates with other entities/departments to resolve identified issues with demonstrated improvement in operational flow.
Demonstrates resolution of operational issues with targeted outcomes as negotiated with the Director.
Regulatory compliance Maintains work place in safe condition.
Assure appropriate chair height, keyboard and screen placement, securing electrical wiring, observing departmental safety policies and procedures.
Reports safety hazards within 1-3 days from time problem first identified.