Contracts Specialist, Sr. (18062-071317)
The Contracts Specialist, Sr. contracts with a variety of health care providers needed to serve CalOptima members. This position will be in contact with a variety of provider types, including individual physicians, physician groups and ancillary providers for contracting purposes. The Sr. Contracts Specialist will negotiate, implement and manage provider contracts.
Position
Responsibilities:
Introduce CalOptima contracts to potential providers.
Negotiate rates within CalOptima payment guidelines.
Work closely with the Manager and Director of Contracting to develop and implement contracting strategies.
Keep Manager and Director abreast of contracting progress, issues and concerns.
Respond to provider questions and inquiries regarding contract language and rates.
Coordinate with key departments to credential and load new providers into the Facets database.
Clearly communicate with internal departments regarding provider contract obligations and rates.
Prepare detailed reports regarding contracted provider network.
Other projects and duties as assigned.
Required Skills
Communicate effectively with internal departments and external customers.
Request and interpret applicable financial data from CalOptima's Finance and Claims departments to analyze the impact of rate increases or the implementation of other payment methodologies.
Negotiate contract compensation based on various methodologies including fee-for-service, capitation and per diems.
Act as a contracting liaison between the provider and CalOptima.
Interpret contract language and rate schedules.
Respond appropriately to contracted provider inquires and coordinate resolution.
Become familiar with CalOptima's internal business systems (i.e. Arriba and Facets).
Plan and facilitate meetings.
Prioritize tasks in order to meet challenging deadlines.
Required Experience
Experience & Education:
High school diploma or equivalent required. Bachelor's degree in Business Administration, Health Care Administration or other related field preferred.
3
years of experience in the health care field interacting directly with providers.
Health care contracting experience preferred.
Valid driver's license and vehicle, or other approved means of transportation, and current auto insurance may be required for work away from the primary office approximately 5% of the time.
Knowledge of:
Microsoft Outlook, Word and Excel.
Other computer applications required to maintain and track provider contracts.
Managed care contracts and various reimbursement methodologies, health plan delivery models (capitation vs. fee-for-service Medicare, Medi-Cal, commercial plans, etc).
Guidelines and regulations specific to the health care field.
Grade: M
#CB
Job LocationOrange, California, United StatesPosition TypeFull-Time/Regular
Apply
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
Position
Responsibilities:
Introduce CalOptima contracts to potential providers.
Negotiate rates within CalOptima payment guidelines.
Work closely with the Manager and Director of Contracting to develop and implement contracting strategies.
Keep Manager and Director abreast of contracting progress, issues and concerns.
Respond to provider questions and inquiries regarding contract language and rates.
Coordinate with key departments to credential and load new providers into the Facets database.
Clearly communicate with internal departments regarding provider contract obligations and rates.
Prepare detailed reports regarding contracted provider network.
Other projects and duties as assigned.
Required Skills
Communicate effectively with internal departments and external customers.
Request and interpret applicable financial data from CalOptima's Finance and Claims departments to analyze the impact of rate increases or the implementation of other payment methodologies.
Negotiate contract compensation based on various methodologies including fee-for-service, capitation and per diems.
Act as a contracting liaison between the provider and CalOptima.
Interpret contract language and rate schedules.
Respond appropriately to contracted provider inquires and coordinate resolution.
Become familiar with CalOptima's internal business systems (i.e. Arriba and Facets).
Plan and facilitate meetings.
Prioritize tasks in order to meet challenging deadlines.
Required Experience
Experience & Education:
High school diploma or equivalent required. Bachelor's degree in Business Administration, Health Care Administration or other related field preferred.
3
years of experience in the health care field interacting directly with providers.
Health care contracting experience preferred.
Valid driver's license and vehicle, or other approved means of transportation, and current auto insurance may be required for work away from the primary office approximately 5% of the time.
Knowledge of:
Microsoft Outlook, Word and Excel.
Other computer applications required to maintain and track provider contracts.
Managed care contracts and various reimbursement methodologies, health plan delivery models (capitation vs. fee-for-service Medicare, Medi-Cal, commercial plans, etc).
Guidelines and regulations specific to the health care field.
Grade: M
#CB
Job LocationOrange, California, United StatesPosition TypeFull-Time/Regular
Apply
. Apply now!Estimated Salary: $20 to $28 per hour based on qualifications.
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