Senior Provider Contract Specialist

Location:

Calmont Operations Building

Department:

Network Mgmt

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi-specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State guidelines; Recruit and develop network for a region and set of providers; Lead assigned recruitments (i.e., physician, hospital and ancillary) and ensure they result in complete and accurate standard contracts that meet objectives; Facilitate and oversee to the provider set-up and contract configuration to ensure accurate claims adjudication; Initiate contact and identify potential providers by geographic and specialty needs and update database; Evaluate and monitor providers' performance standards and financial performance of contracts; Develop contracting action plans; Coordinate with internal departments and contracted providers to implement and maintain contract compliance

Additional Information:

Coordinate and negotiate hospital, physician (IPAs, PPMs, individual providers, multi-specialty groups) and ancillary service agreements that are in accordance with corporate, health plan and State guidelines; Recruit and develop network for a region and set of providers; Lead assigned recruitments (i.e., physician, hospital and ancillary) and ensure they result in complete and accurate standard contracts that meet objectives; Facilitate and oversee to the provider set-up and contract configuration to ensure accurate claims adjudication; Initiate contact and identify potential providers by geographic and specialty needs and update database; Evaluate and monitor providers' performance standards and financial performance of contracts; Develop contracting action plans; Coordinate with internal departments and contracted providers to implement and maintain contract compliance

Education:

• Bachelor's degree, with 5 years' experience or Associate's degree, 10 years' experience working with healthcare providers, ancillary or hospital groups in a health plan setting preferred otherwise.
• Strong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arena.
• Proven contract preparation skills, with an in-depth knowledge of Medicaid and other reimbursement methodologies.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency in MS Office applications.
• Experience working with healthcare providers, ancillary or hospital groups.
• Experience working with Texas Medicaid.

• Contracting Certification
• Provider Relations experience
• Experience with ACO/Risk Contracting
• Value based contracting experience
• CRM experience
• Project Management experience/certification