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Provider Contracts Specialist

Company: Imperial Health Plan of California
Location: Pasadena
Posted on: August 17, 2019

Job Description:

Provider Contracts SpecialistJob Description: The Provider Contracts Specialist is accountable for the management of the contracting and network management activities to ensure superior access, cost-effective Providers of healthcare services for our Members and competitive in the marketplace for Imperial Health Plan. This includes network development, sourcing of Providers, contract negotiation, and measuring, monitoring and reporting on the status of contract agreements and relationships. In addition, this position has administrative responsibility for representing Imperial Health Plan in its relationships with its contracted providers and provide internal support to Provider Services representatives. Job Functions:-- Develop a Provider network comprised of physicians, hospitals and ancillary groups that is competitive and provides broad healthcare access to patients. -- Negotiate and build a stable Provider network-- Evaluate and negotiate contracts with healthcare Providers in compliance with contract templates, reimbursement structure standards, and other key process controls.-- Establish and maintain relationships with healthcare Providers, and ensure the network composition includes an appropriate distribution of Provider specialties.-- Collaborate with various cross-functional departments within the organization to ensure the timely & accurate implementation of new contracts.-- Coordinate and implement the installation of new Provider contracts with each Provider office and their staff, including written procedures for billing, eligibility verification and other contractual requirements.-- Assist in resolving elevated and complex Provider complaints and/or escalated issues with internal/external partners/customers.-- Maintain the provider network directory.-- Create, develop and enhance documented processes & procedures relative to Cost Containment, Contracting and Provider Relations. -- Provide effective reporting of cost containment developments and Provider contract status on a regular basis;-- Prepare and provide monthly management reports on participating and non-participating providers-- Ensure regulatory and statutory compliance of Provider contracts and execute on remediation efforts.-- Proactively build and manage key Provider relationships and ensure appropriate interface with Providers and business staff Employee Type: Full TimeEducation: Four Year DegreeExperience: 5 YearsTravel: Up to 25%Job Requirements: -- Bachelor's degree in Business, Healthcare or similar field preferred and/or five years of experience in Provider contract components, fee schedule determination, credentialing, claims processing and pricing;-- Exceptional in-depth healthcare/insurance knowledge for medical and dental Provider relations and operations;-- 3+ years of experience in a healthcare network development, network contracting, account management, Provider services, Provider contracting, etc.-- Knowledge of Provider fee schedule developments in DRG, CPT, CDT, RBRVS and HCPCS;-- Advanced computer software skills in word processing, spreadsheet and database management;-- Possess a high attention to detail with strong analytical and mathematical skills-- Effective project management skills and the ability to manage multiple projects at one time; -- Motivated self-starter with the ability to prioritize, multi task, work under pressure and tight deadlines, work independently and effective problem solver.-- Possess strong communication and interpersonal skills;-- Strong presentation skills;-- Ability to work overtime based on the department's needs;-- Verifiable, clean DMV Record and the ability to travel to locations throughout the US (mainly California). Approximately 25% travel time.

Keywords: Imperial Health Plan of California, Pasadena , Provider Contracts Specialist, Other , Pasadena, California

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