Supervisor, Provider Contracting Specialists

Job Description

The Provider Contracting Operations Supervisor will be responsible for overseeing the reviewing and delivery process of onboarding provider data to ensure integrity and accuracy. Maintain contract templates and other documents to ensure compliance upon completion, create and manage policies & procedures, and coordinate with other business units to ensure cohesion. Manage CMS and Medicaid opt-out and exclusion processes.

To perform this job successfully, an individual must be able to perform the job description satisfactorily. This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Responsibilities

Excellent verbal and written communication skills.

Detail oriented and analytical.

Strong organizational skills.

Ability to manage multi-level and complex organizational structures.

Managed Care operations and regulatory requirements for all lines of business.

FFS and Capitation contractual arrangements with Primary Care and Specialist providers.

Solid understanding of provider contracting processes.

Detail knowledge of systems utilized for provider contracting operations.

Detail knowledge of Commercial, Medicare, and Medicaid program guidelines.

Possess working knowledge of provider contracts and/or regional application of contracting methodologies.

Must have the ability to analyze and process all types of contract documents and templates accurately utilizing advanced level knowledge of regulations.

Must possess the ability to effectively present information and respond to questions from managers, employees, customers

Must possess advanced reasoning and problem-solving abilities and planning skills.

Ability to multi-task, prioritize, and work in a fast-paced environment under minimal supervision.

Proficient in Excel including the ability to create and revise Excel spreadsheets to provide accurate and clear reports.

Requires a dynamic person with the ability to work in a fast-paced environment

Requires the ability to accept feedback and implement changes effectively

Requires ability to coach staff, to influence colleagues in a positive, effective manner

Excellent relationship-building skills and embodying Prospect cultural values

Excellent Written/verbal And Organizational Skills Are Required.

Must be proficient in Excel and Word skills.

Preferred Proficiency In Evips/Payer 5 Systems Or Similar

Must be self-motivated and possess the ability to complete tasks independently within established timeframes.

This role is 100% remote.

Qualifications

Required Education/Experience

Bachelor’s degree or five years of relevant experience.

Contract administration in a managed care environment.

3 years of experience entering data in a provider data platform.

2 years of experience leading/training staff directly or indirectly.

Preferred Education/Experience

Bachelor’s degree in Business Administration or similar field of study.

3 years of experience in managing staff.

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.