Contract Specialist

Summary/Position Objectives: Develops, analyzes, negotiates, and implements cost effective, contractual agreements with healthcare providers and institutions that can be administered efficiently and are in compliance with state and federal regulatory requirements. Responsibilities: Essential Functions: Evaluates current contracts, renegotiates where applicable, and applies managed care reimbursement principles (capitation, per diems, creative reimbursement, etc.) to maximize cost savings, while maintaining quality. Researches current and new contract operational procedures, coordinates with appropriate departments, to streamline processes wherever possible. Oversees initial and ongoing cost/benefit analysis of contracts to determine cost effectiveness, renegotiating as appropriate. Oversees annual analysis & reconciliations of major contracts. Researches and prepares RFP's and letters of interest, analyzing results and making recommendations to Manager and Director of Network Development & Contracting. Coordinates implementation of new contracts with departments involved. Coordinates internal review and determine/evaluate administrative feasibility throughout the continuum of the contracting process. Serves as an internal resource to MCP departments regarding managed care and contractual issues as they arise, and participates in various Committee meetings. Ensures appropriate legal / regulatory review of contracts prior to execution. Drafts, recommends and writes both standard and specialized contracts, ensuring that all required components are included. Coordinates and chairs monthly and quarterly meetings with Ancillary providers Drafts and negotiates Letters of Agreements as requested by Medical Management Departments obtaining appropriate legal & management review & approval. Negotiates and amends contracts as required per updated new AHCCCS mandates. Completes system configuration requests for all provider network changes and modifications; and ensures compliance with AHCCCS technical requirements for reporting and encounter submission. Responds to provider correspondence and telephone inquires. Secondary Functions: Works in a manner that is not disruptive to peers, supervisors and/or subordinates. Maintains regular and acceptable attendance at such level as is determined in the employer’s sole discretion. Maintains availability and willingness to work such days and hours as the employer determines are necessary or desirable to meet its business needs. Maintains availability and willingness to travel to such locations and with such frequency as the employer determines is necessary or desirable to meet its business needs (if travel required). Provides training in user specific areas of referral network and procedures, pre-authorization, coding, (ICD-9, UB 92, CPT-4) and billing (HCFA 1500, UB92). Maintains professionalism, including phone etiquette manners, appearance, and attitude. Maintains effective working relationships with various providers, networks, and managed health care components. Continues education regarding changes and trends in health care management and specific provider communities. Performs other related duties, assignments and responsibilities as assigned or required.
REQUIREMENTS
Knowledge and Skills: Incumbent must have: skills in contract negotiation and relations, and effective problem-solving abilities, the ability to read, comprehend, and negotiate contracts and services at an effective level; the ability to communicate effectively, write correspondence, procedures and policies, and supporting documentation; the ability to present information effectively in one-on-one and small group settings to providers and employees; and the ability to use effective reason to define problems, collect data, establish fact, draw valid conclusions, and design, implement, and manage appropriate action plans. This position must have skills to capably handle multiple priorities. Incumbent must have effective and meticulous organization and coordination. Incumbent must be a positive team player able to manage project time constraints and work with little supervision. Incumbent must be able to successfully utilize QMACS/QNXT software, Microsoft Office Suite and common computer and office hardware. Education and Work Experience: Bachelor degree in business, health, management systems or closely related field is preferred, although an equivalent combination of formal education and experience may substitute for a degree. Incumbent must have a minimum of three years professional-level healthcare contracting experience. Demonstrated experience with large provider organizations, ancillary and hospital providers, common coding, and billing requirements is required. Advanced interpersonal skills, maturity, and good judgment are required. Working experience with QMACS/QNXT is helpful. Incumbent must possess reliable transportation with proper insurance coverage, and be available for extensive travel. This position requires work experience in a complex, competitive environment with diverse racial and socio-economic factors. Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits: * Competitive compensation DOE * Medical, Dental and Vision insurance * Employee Assistance Program * Flexible spending accounts * On-site fitness center (Phoenix headquarters only) * Life insurance and accidental death and dismemberment insurance * Short-term and long-term disability * Paid holidays, paid time off/paid time off reserve * 401(k) * Tuition reimbursement Visit www.schalleranderson.com for more information or submit a resume to [Click here for email]. EOE