Senior Provider Relations/Contract Specialist

Scripps Health•San Diego, CA

2d•Hybrid

About The Position

The Senior Provider Relations/Contract Specialist is the liaison between the medical groups, network providers and Scripps Clinic Health Plan Services. Decision making authority regarding processes related to the contractual arrangements. Responsibilities may include, but are not limited to: reporting, auditing, documentation, communication, training and effective resolution of issues. Ensures exceptional customer service and builds effective relationships between the organizations. Attends meetings at medical groups to provide input and support in relation to managed care. Thoroughly researches issues and interacts with management in Managed Care Operations to facilitate effective processes. Assists in network contracting ensuring ease of implementation of contracts and standardization of rates whenever possible.

Requirements

Bachelor's degree in business/health care field or equivalent experience.
Minimum 5 years managed care experience.
Exceptional customer service skills with proven ability for effective follow-up.
Claims payment, contract interpretation and knowledge of contracting terms required.

Nice To Haves

Experience with Provider Relations.
Worked for a Medical Group or Health Plan.
Epic Tapestry experience.
Contract financial modeling experience.

Responsibilities

Reporting
Auditing
Documentation
Communication
Training
Effective resolution of issues
Ensuring exceptional customer service
Building effective relationships between organizations
Attending meetings at medical groups to provide input and support in relation to managed care
Thoroughly researching issues and interacting with management in Managed Care Operations to facilitate effective processes
Assisting in network contracting ensuring ease of implementation of contracts and standardization of rates whenever possible