- Negotiate and draft agreements and amendments outlining contractual terms as directed.
- Engage in specialty provider recruitment efforts to support network adequacy requirements.
- Present contracts and amendments for execution.
- Draft provider terminations and other provider correspondences.
- Initiate Alerts 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 Claims 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
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Contract Specialist - Orange, United States - Prospect Medical Holdings
Description
Job DescriptionSupports contracting efforts in assigned region for owned and MSO business relationships. Negotiate and draft agreements, amendments, Open Ended Memorandum of Understandings (MOUs), and Patient Specific MOUs. 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
Minimum Education: Associates degree or equivalent education and experience preferred.
Minimum Experience: 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.
Req. Certification/Licensure: None.
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.
