About Our Company
At Altais, we're looking for bold and curious innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, patients, and the clinical community. Doctors today are faced with the reality of spending more time on administrative tasks than caring for patients. Physician burnout and fatigue are an epidemic, and the healthcare experience and quality suffer as a result. At Altais, we’re building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve.
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About Your Team
Are you looking to work with a high performing, fast growing and dynamic Contracting team? Altais and our subsidiaries, form one of the most recognized medical groups in California. We are 3,000+ physicians, working in over 40 cities in California, caring for more than 350,000 patients. If working in a mission driven organization supporting highly competent, hard-working, thoughtful clinicians who value good ideas and are passionate about reshaping healthcare excites you, then we are thrilled to welcome you to your new career.
This position is located remotely (within the state of California). We are flexible provided you are open to traveling to the Oakland office locations as needed.
About Your Work
Responsible for managing and negotiating payer contracts for all lines of business; Commercial, Medicare and Medi-Cal HMO, PPO, and ACO for multiple medical groups and Independent Physician Association’s throughout California. Primary duties include health plan operations, contract analyses, negotiations and contributing to operational implementation.
You Will Focus On
- Effectively conducts negotiations with health plan and payer partners to achieve operational efficiency and budgeted results on a timely basis with moderate supervision:
- Conducts review of historical/potential financial performance of the contracts, using MLR financial reports and previous negotiation history.
- Prepares negotiation letters and sends them out in a timely manner to begin negotiations.
- Tracks negotiation history and creates rate comparison grids and other resources to show negotiation progress.
- Researches the effect of contract and financial terms with operating departments.
- Work with other departments to ensure operational concerns are addressed in new contracts.
- Ensures contract language abides by state and federal law and community standard. Any deviations from language must be signed off by the appropriate department lead and/or Legal.
- Drafts and implements accurate and timely written communication pieces regarding new and renewed health plan payer arrangements and to the network and appropriate departments, including:
- Tracks all negotiations for senior executives.
- Communicates results of the finalized arrangement for presentation to internal departments as appropriate, i.e. some redacted versions.
- Solicits information and feedback from operating departments regarding, implementation and performance of contracts as required.
- Maintains all health plan payer contract data in a Health Plan Contract Summary grid or contract management database with reportable functionality.
- Develop and maintain successful relationships with Health Plan Payer partners and maintain a contact list of all levels of health play payer partner contracting staff.
- Participates in strategic and operational planning for the health plan payers and facilitates the execution of the plan.
- Act as liaison for resolution of problems related to the operations of all health plan contracts.
- Represent in meetings and collaborate at all levels to share updates, continuously improve operations, processes and partnerships.
- Maintain organization of health plan payer resources on intranet shared site, i.e. Provider Manuals, Contact List, Communication Notices, DOFR’s, Delegation Agreements, etc.
- Support Provider Contract negotiations, as necessary.
- Conducts organizational in-service/education of organization on health plan payer relationship and contract terms.
- Performs all office functions accurately within reasonable limits based upon established needs and specified deadlines.
- Accepts and performs other related duties and responsibilities as required.
The Skills & Experience You Bring
- Strong problem-solving, advanced communication and analytical skills required to develop positive working relationships both internally and externally. Well developed negotiating and managed care operations skills required. Training and Education skills strongly preferred. Financial analysis skills and contracting regulatory skills strongly preferred. Strong written communications skills and strong Excel spreadsheet skills are required. Ability to multi-task and manage multiple projects simultaneously is required.
- BA or equivalent education and experience required
- Minimum of five (5) years of managed healthcare contracting experience necessary to have acquired and demonstrated skills and abilities listed above or the approved equivalent
- At least three (3) years working for a health plan or medical group/IPA
Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate’s starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our ‘CPRA Privacy Notice for California Employees and Applicants’ to learn how we collect and process your personal information when you apply for a role with us.
Altais is a leading network of independent doctors focused on delivering personalized and high-quality health care in over 40 cities in California. Its network of more than 3,000 physicians, serving more than 355,000 HMO, ACO and PPO patients, is dedicated to improving care and reducing costs through innovative care management and care coordination programs, use of health care technology, and population health management strategies. For more than 30 years, Altais and its family of companies has proudly collaborated with leading hospitals and health plan providers to provide high quality care in California
Please note that Brown & Toland Physicians is a wholly owned subsidiary of Altais Clinical Services, a division of Altais. Other subsidiaries in the Altais family of companies include Altais Medical Group Riverside and Family Care Specialists Medical Group.
If you would like to search for other open positions within the Altais family of companies, please view the links below:
· Altais Medical Group Riverside (https://altais.com/altais-medical-group-riverside/employment-opportunities/)