Salary Estimate: $81848.00 - $122824.00 / year
Learn more about the benefits offered for this job.
The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

JOB SUMMARY AND QUALIFICATIONS

The Contract Specialist is responsible for understanding the terms of all HMO and PPO contracts, and at the direction of the Contracting Team, interface with health plans to negotiate HMO and PPO rates and Division of Financial Responsibility (DOFR).
This role is responsible for drafting and maintaining Network Provider agreements, at the direction of the President of SCCIPA and the Contracting Team.
This role is also responsible for co-leading the Contracts Governance Team which serves to inform and notify key PPMSI stakeholders about new/modified health plan contracts, including DOFRs, and new/modified provider agreements, and is considered the lead on implementation of such contracts to ensure functions such as Claims System Configuration, Customer Service, Utilization Management and Compliance are executing their assigned accountabilities.
This role is also accountable for co-leading the weekly Contracting Team meeting by preparing the agenda and open items for discussion and decision. The members of the Contracting Team include the CEO, CFO, President of SCCIPA, AVP Claims and Manager of Network Operations. We want you to apply!

What you will do in this role:

• Complete understanding of all contract terms, including the Division of Financial Responsibility
• When negotiating health plan contracts, accountable for reviewing and getting approval of the Division of Financial Responsibility (DOFR) from the President of SCCIPA and the CFO
• Accountable for drafting, reviewing and getting approval from the President of SCCIPA, any Network Provider or ancillary provider contract and its terms. Any deviation from standard terms requires financial analysis and additional approvals from the Contracting Team.
• Track assigned health plan termination dates, notifying the Contracting Team of upcoming renewal dates
• In conjunction with the CFO, finance team and Contracting team, provide analysis and recommendations for terms, sharing experience and market knowledge
• Provides interpretation of contract and DOFR terms to others in the organization to ensure contract is implemented and executed accurately
• May do analysis in conjunction with Finance or the Claims team to ensure claims payments are accurate, and participate in claims system configuration audits as needed
• Draft and prepare for review by the President of SCCIPA and CFO Letters of Agreement as directed
• Accountable for submitting monthly physician rosters to health plans based on Credentialing Committee approvals
• Accountable for storing and archiving agreements in a systematic, organized fashion

People

• Fosters an environment that promotes PPMSI Guiding Principles of Operational Excellence, Customer-Service Mindset, Equitable & Accessible Care, Respect & Compassion for All, A Trusted Partner to Physicians, a Trusted Partner in the Healthcare Journey for our members and supports a Growth Mindset for local, sustainable growth.
• Ensures a continuous learning organization, encouraging and promoting idea generation
• Builds trust and acts with authenticity
• Delivers information in a clear, concise and compelling manner
• Ensures strong sense of accountability amongst teams with measurable metrics, dashboard reporting and honest, timely performance feedback

What Qualifications you will need:

EDUCATION:

• Bachelor’s degree in Business or related field required

EXPERIENCE:

• Minimum 5 years equivalent work experience negotiating and managing contracts either in a health plan or IPA/MSO model
• Experience negotiating DOFRs, physician and ancillary agreements and Letters of Agreement
• Working knowledge of claims operations, credentialing process and overall MSO operations
• Minimum of three years of claims experience and/or one year of provider operations work required

• Complete understanding of all contract terms, including the Division of Financial Responsibility
• When negotiating health plan contracts, accountable for reviewing and getting approval of the Division of Financial Responsibility (DOFR) from the President of SCCIPA and the CFO
• Accountable for drafting, reviewing and getting approval from the President of SCCIPA, any Network Provider or ancillary provider contract and its terms. Any deviation from standard terms requires financial analysis and additional approvals from the Contracting Team.
• Track assigned health plan termination dates, notifying the Contracting Team of upcoming renewal dates
• In conjunction with the CFO, finance team and Contracting team, provide analysis and recommendations for terms, sharing experience and market knowledge
• Provides interpretation of contract and DOFR terms to others in the organization to ensure contract is implemented and executed accurately
• May do analysis in conjunction with Finance or the Claims team to ensure claims payments are accurate, and participate in claims system configuration audits as needed
• Draft and prepare for review by the President of SCCIPA and CFO Letters of Agreement as directed
• Accountable for submitting monthly physician rosters to health plans based on Credentialing Committee approvals
• Accountable for storing and archiving agreements in a systematic, organized fashio