Managed Care Contracts Specialist (Full-Time, 40 Hours, Day Shift)

RESPONSIBILITIES

I. JOB SUMMARY/RESPONSIBILITIES:

• Assists in development, maintenance and administration of the medical centers’ contracts with health insurers for services provided to members.

• Performs financial analysis, operational evaluation, and compliance issues on payer agreements to recommend action for executive review.

• Makes recommendations for optimal member utilization and objective financial criteria.

• Functions as a member of the contracting team to negotiate optimal contractual agreements.

• Responsible for maintenance of contract modules.

• Serves as a liaison with selected payers to promote the service of the medical center and improve provider relations with third party payers.

II. TYPICAL PHYSICAL DEMANDS:

• Essential/continuous: Sitting, finger dexterity seeing, hearing, speaking, repetitive arm/hand motions, static gripping of an object for prolonged periods, frequent gripping of an object.

• Operates computer, typewriter, calculator, telephone, fax and printer.

III. TYPICAL WORKING CONDITIONS:

• Not substantially subjected to adverse environmental conditions.

IV. MINIMUM QUALIFICATIONS:

A. EDUCATION/CERTIFICATION AND LICENSURE:

• Bachelor’s degree in Business, Finance or Health Care Administration or four (4) years with health care provider or payer in contracting or business operations.

• Master’s degree in related field preferred.

• Knowledge of healthcare delivery systems, including contracting and financial analysis.

• Knowledge of current regulatory billing and collection policies and procedures.

• Knowledge of computer assisted analytical tools including word processing, spreadsheet, and software for hospital contract and/or claims management.

B. EXPERIENCE:

• In additional to the educational requirement, two (2) years experience with a health care provider or payer in contracting or business operations.

• Demonstrated ability to work independently and effectively with internal and external personnel at various levels of responsibility.

Equal Opportunity Employer/Disability/Vet