Job description
Provider Contracting Specialist – Managed Care
Remote, CA
Provider Contracting Specialist Job Summary:
Provider Contracting Specialist Background:
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#CARE4
Remote, CA
Provider Contracting Specialist Job Summary:
- Negotiate and maintain provider contracts including but not limited to hospital renewals, negotiations, analysis and day-to-day service issues and operations; ancillary providers; ancillary facilities; individual and small group physicians.
- Need to understand, negotiate, implement, and support complex value-based provider contracts with key hospital and physician providers.
- Ability to evaluate different reimbursement methodologies.
- Work with Finance Department to determine the financial impact of changing reimbursement methodologies with key providers.
- Assist Provider Appeals in the research and resolution of hospital and provider appeals.
- Assist Provider Relations with inquiries and concerns and compliance regarding billing policies and payment rates.
- Maintain fee schedule and payment rate library.
- Assess financial impact of new provider contracts.
- Analyze impact of change in existing provider contracts.
- Ownership of specific Vendor relationships and day-to-day service operations.
Provider Contracting Specialist Background:
- Bachelor’s degree required, Master's degree preferred.
- Requires 3 or more years of experience in provider contract negotiations, ideally in a managed care environment.
- Some experience with contract implementation is highly preferred.
- Procurement and/or Purchasing experience is not relevant/helpful.
- Knowledge of multiple provider contracting models and arrangements is required.
- Requires strong analytical skills with Excel; must be able to manipulate, index, and query data in multiple views and formats.
- Strong computer skills including Microsoft Word, Excel, PowerPoint, Access required. (Amisys knowledge preferred but not required).
- Detail oriented, organized and self-directed person with the desire to learn.
- Demonstrated ability to communicate clearly and work cooperatively with other agency personnel as well as diverse social and economic communities.
- Demonstrated ability to perform tasks involving independent judgment; prioritize multiple projects and manage deadlines; improve systems and increase system efficiencies.
#ADMIN
#CARE4
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