Job Description
Job Description
Job Title: Contracts Specialist
Summary:
Description:
Position Information:
- Department: Contracting
- Work Arrangement: Full Office
- Work Schedule: Monday through Friday, 8:00 a.m. - 5:00 p.m.
Duties & Responsibilities:
- 95% - Contract Support
- Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
- Evaluates out of network requests from medical management, assesses in-network providers for redirection and attends daily staff meetings to discuss outcomes.
- Negotiates single patient agreements for members directed out of network and serves as a point of contact for provider inquiries.
- Updates and reviews desktop procedures and identifies opportunities for improvement.
- Assists Contracts Managers with contract creation, distribution and collection of outstanding contract documents.
- Maintains electronic library of provider contacts and contracts on shared drive and contract management system/database.
- Responds to inquiries regarding contract status, network rosters, provider reimbursement and application/credentialing status in a timely manner.
- Keeps department management abreast of issues and concerns regarding contracts, projects and tasks.
- 5% - Other
- Completes other projects and duties as assigned.
Minimum Qualifications:
- Associate degree PLUS 2 years of work experience related to managed care or related field required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
Preferred Qualifications:
- Experience negotiating single patient agreements, professional and ancillary contracts.
Experience with elementary data analysis.
Required Licensure / Certifications:
- N/A
Knowledge & Abilities:
- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.