Contract Specialist

Job Details

Job Location
Main Office - Santa Barbara, CA

Job Category
Provider Services

Description

Central Coast Salary Range:$76,466 - 110,875

Job Summary

This position is responsible for the coordination, processing, and maintenance of the provider contracting process within the Provider Services Department.

Prepares provider agreements and amendments for new and existing providers, and coordinates the regular review of contract terms. Participates in a team setting to ensure provider contracts are executed and inquiries are addressed in a timely manner.

Works collaboratively with departmental staff, legal team, administration and other personnel involved with contract and reimbursement development processes. Primary external contacts include health care providers.

Duties & Responsibilities

• Prepares provider contracts, letters of agreement, and amendments
• Negotiates reimbursement terms with providers for single member agreements
• Coordinates the regular review of contract language, terms, renewals, and amendments
• Analyzes the impact and risks of proposed changes to contractual language, coordinating with internal stakeholders
• Monitors and researches provider contract changes; assists with coordinating system configuration changes needed resulting from contract changes
• Creates and maintains accurate contract files, and maintains systems for tracking documents and contractual data
• Using knowledge of provider contracts and reimbursement topics to conduct research, interpret, and respond to external (provider) and internal (staff) inquiries
• Compose provider correspondence, including notifications and cover letters
• Coordination and regular communication with Provider Services Representatives, Provider Data and Credentialing teams, and other stakeholders throughout the contracting and onboarding processes
• Collaborates with departmental staff, legal team, administration and other personnel involved with contract development and approval processes
• Provides training to Provider Services staff regarding contracts
• Assists with projects resulting from State or regulatory requirements and audits
• Participates on workgroups and committees covering topics such as contracting, network strategy, internal processes and procedures
• Make recommendations to management team for improvement of any and all procedures and systems at CenCal Health
• Assist the Provider Contracts Manager and senior management with special projects including reimbursement analyses, regulatory requirements, and process improvements
• Other duties as assigned

Qualifications

Knowledge/Skills/Abilities

• Excellent organizational skills, must be detail oriented
• Must have strong research and analytical skills, including data analysis and problem solving
• Must have excellent computer skills, including Microsoft Office and Excel
• Must have strong oral and written communication skills and the ability to maintain effective, professional, and cooperative working relationships
• Proficient in interpretation and assessment of contract terms and language
• Knowledge of healthcare provider reimbursement, claims, and revenue cycle strongly desired
• Knowledge of negotiation concepts and skills strongly desired
• Understanding of managed care concepts, networks, and insurer obligations desired
• Ability to perform effectively under pressure, complete tasks accurately within established timeframes and work independently
• Maintains confidentiality of sensitive information
• Effective at prioritizing multiple tasks and deadlines and ability to understand and interpret contract language
• Excellent attention to detail required

Education & Experience

• Bachelor's Degree or equivalent experience in healthcare administration
• Experience with document management software desired
• Experience in contract language drafting, editing, and analysis required
• Experience in managed care contracting preferred