Provider Contracts Specialist III

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive. This enables us to create the health plan of the future and do our best work –Together.

GCHP allows a flexible work environment so employees can work from a home location or in the office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on our 5 Core Values:

• Integrity

• Accountability

• Collaboration

• Trust

• Respect

Disclaimers:

• Flexible work schedule is based on job duties, department, organization, or business need.

• Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

Under the direction of the The Director, Provider Network Ops, Program and Policy, the Provider Contract Specialist III performs a range of duties including negotiations of provider contract terms, prepare contracts amendments and renewals, and perform provider rate analysis. You will prepare and disseminate information to appropriate stakeholders regarding contract status and necessary contract updates, renewal amendments, and terminations. To succeed in this role you need to detect the errors and inconsistences in contracts and have strong knowledge of standard provider contract boilerplates clauses as well as interpret contract language and rates in response to questions or claims resolution.

Essential Functions Statements

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

• Draft review, analyze and prepare various types of contracts, renewals and amendments according to regulatory guidelines and under appropriate legal supervision

• Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers as well as internal stakeholders

• Assist in the development of pertinent policies and procedures pertaining to contract preparation and approval process

• Manages detailed and organized electronic filing system for all contracts using applicable operational systems and keeps the system up to date.

• Provider contract data reports and dashboards for management and stakeholders • Knowledge of provider credentialing and liase with key credentialing stakeholders

• Perform rate analysis using rate analysis tool

• Seeks legal and compliance assistance as appropriate through designated counsel in connection with proposed contractual arrangements and contract updates and revisions

• Train Contract Specialist I and II as needed

• Supports or leads state mandated provider network initiatives

• Prepare and present training decks or presentations

QUALIFICATIONS

• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

• Interpersonal - Ability to get along well with a variety of personalities and individuals.

• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

• Communication, Oral - Ability to communicate effectively with others using the spoken word.

• Communication, Written - Ability to communicate in writing clearly and concisely.

SKILLS & ABILITIES

Education: Bachelor's degree in related field or an equivalent combination of education and experience

Experience:

• Minimum of 7 years of provider service experience and physician, hospital, ancillary, and health plan contracting

• Minimum of 7 years of experience with varying payment methodologies and value base contracting, such as: Pay for Quality/Performance, DRG, APC, ASC, Capitation, Fee for Service, RBRVS, Per Diem, and Per Case

• Strong understanding of State of California Governmental Programs Contract Requirements and Reimbursement Methodology and Medicare Contract Requirements and Reimbursement Methodologies

• Strong understanding of value based / risk based contracting arrangements

• Strong understanding of managed care and accountable health system models and relationship to contracting strategy and reimbursement methodology

• Proficient knowledge of legal requirements pertaining to relevant contracts

Computer Skills:

• Proficient in MS Office, Excel, Word Outlook and PowerPoint

• Understanding SharePoint and metadata

Certifications and Licenses: Valid CA Driver’s License

Apply Here

PI253859935