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Contract Specialist at CareOregon in Remote
Job Description
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The Contract Specialist negotiates, develops, and maintains provider contracts throughout the state and region which are routine or moderately advanced in nature. This position serves as a resource regarding contract language and terms. This position builds and maintains positive, effective relationships with contracted provider network with attention to ongoing service needs, as well as with internal departments impacted by contract changes. The Contract Specialist identifies expense outliers, performs routine financial analysis, and recommends reimbursement ideas. Area of focus may be Provider Network Contracting or Value Based Contracting.Estimated Hiring Range:
$72,765.00 - $88,935.00Bonus Target:
Bonus - SIP Target, 5% AnnualCurrent CareOregon Employees: Please use the internal Workday site to submit an application for this job.
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Essential Responsibilities
Administer the internal contracting process and external network relationships for assigned areas. Work will be focused in one of the following areas:
Provider Network Contracting:
Primary areas of focus include ancillary providers (lab, imaging, physical therapy), home health, vision, durable medical equipment, medical supplies, skilled nursing facilities, pharmacy benefit managers, and other organizations
Identify and contact potential providers for inclusion in network, including initiatives pertaining to member access and geographic expansion
Coordinate accuracy and maintenance of provider payments with System Coordinators
Perform and review routine to moderately advanced financial analysis with Provider Services Director and Finance staff
Value Based Contracting:
Coordinate accuracy and maintenance of provider payments with Accounts Payable
Perform and review routine to moderately advanced financial analysis with Value Based Contracting Manager and Finance staff
Learn and integrate federal and state regulations into contract language.
Negotiate or assist in negotiating contract language and terms.
Negotiate, coordinate, and produce Letters of Agreement and Memorandums of Understanding.
Coordinate production and execution of contracts with Provider Services staff.
Assist in the resolution of provider issues related to contractual relationships.
Build and maintain effective working relationships with contracted provider network with attention to ongoing service needs.
Participate in contracting and networking projects; may serve as lead role for small projects.
Orient CareOregon staff to contracting process; act as a resource to staff on contract-related matters.
Recommend provider payment and network ideas to contract management.
Organizational Responsibilities
Perform work in alignment with the organization’s mission, vision and values.
Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open-mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Experience and/or Education
Required
Minimum 3 years’ experience in health plan or heath care operations, including, some or most of the following: customer service, claims, contracting, provider relations, or network development.
Knowledge, Skills and Abilities Required
Knowledge
Knowledge of managed care and the Oregon Health Plan
Growing knowledge of federal Medicare regulations and state Medicaid rules (OARs)
Knowledge of claims administration and ability to implement contract reimbursement terms
Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), and ability to perform rate calculations
Knowledge of physician group, hospital, and facility operations
Skills and Abilities
Strong verbal and written communication skills
Word processing, spreadsheet, and database skills
Ability to learn and negotiate facility contract language and terms
Ability to develop and maintain effective relationships with providers and provider groups
Ability to achieve desired outcomes through effective use of negotiation skills
Ability to negotiate and implement routine to moderately advanced reimbursement arrangements
Ability to develop and maintain professional relationships with internal staff and departments
Ability to work with providers, provider groups and other populations in addressing and resolving problems with assistance from management on complex issues
Ability to work independently, organize, prioritize, and manage multiple projects
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, hear, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee’s
personal vehicle, local transit or other means of transportation may be used.
We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.