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Contract Specialist

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

3 years of contract negotiations experience, Familiarity with Medicare and Medicaid fee schedules, Knowledge of Commercial, Medicare, Medicaid services, Associates degree or equivalent experience, Ability to maintain confidentiality.

Key responsabilities:

Negotiate and draft agreements and amendments
Process and maintain contracts in the database
Facilitate resolution of claims and issues
Provide customer service for contracting inquiries
Generate reports and track tasks completion

Prospect Medical Systems SME https://prospectmedicalsystems.com/

501 - 1000 Employees

See more Prospect Medical Systems offers

Job description

Job Description

Supports contracting efforts in assigned region for owned and MSO business relationships. Negotiate and draft agreements, amendments, Patient Specific LOAs. Process, Load, and maintain contracts and providers in contracting database application. Acts as liaison with various internal departments to facilitate and resolve claims, provider configuration, customer service, credentialing, and other related issues.

Responsibilities

Present contracts and amendments for execution. Draft provider terminations and other provider correspondences. Initiate requests for adds, terms, and changes to internal departments for claims and referral system updates, health plan submissions, and member outreach as needed.|Load agreements and providers to contracting data application with all contractual terms and linkages.

Manage Contracting Inquiries email box and Referral Queue.

Negotiate MOUs as needed for referrals to non-contracted providers and secure savings for non-contracted claims.

Provide clarification on contractual arrangements to internal departments, providers and billing companies.|Provides customer service to network providers and other internal departments by responding to contracting inquiries, claims questions, and credentialing inquiries, and provider configuration. Follow up for return of signed contracts, amendments, credentialing applications, and attestations.|Works with credentialing department as needed to obtain credentialing and re-credentialing documents. Provides administrative support to Contract Administrator and Contract Manager. Generate reports as requested and other duties as assigned Track and document tasks to completion.

Qualifications

Three (3) years contract negotiations in a managed care environment working with Medicare and Medicaid fee schedules required. Knowledgeable of Commercial, Medicare, Medicaid lines of business required.Maintain confidentiality and adhere to all regulatory requirements as well as to policies and procedures.Associates degree or equivalent education and experience