Managed Care Contracting Specialist (Remote: AZ, NV, OR, TX, UT)

Job Description

Job Description

JOB TITLE: Contracting Specialist FLSA STATUS: Non-Exempt

DEPARTMENT: Provider Network Management

REPORTS TO: Sr. Manager, Provider Network Management

JOB SUMMARY: Will provide support to Contracting Manager in closing gaps and developing the network. Researching and contracting all specialties and Hospitals in our current counties/states and upcoming states and counties.

ESSENTIAL JOB FUNCTIONS:

1. Will use Microsoft Word/Excel to put together and track emails/ faxes and the necessary paperwork for credentialing and contracting as assigned.
2. Responsible for following up with the providers to collect all paperwork for contracting. Getting the contracts signed.
3. Assist with requests that come through Contracting:

• Contracting (Expansion and current service areas)
• Collect data from the Providers for Credentialing
• Respond to LOA requests.
• Network Gaps analysis and recovery
• Answer provider inquiries on status of credentialing
• Research and call potential new providers for contracting in all service areas new and existing.

1. Assure that all contracts are completed and given to contracting coordinator for upload.

1. Find providers for any incidents that should come into the Contracting queue.
2. Provides a daily/weekly summary of the success rate of the above by geographic region and specialty.
3. Frequently contacts providers via phone to follow up on contracts and credentialing documentation.
4. Travel may be required to visit provider offices to obtain necessary documentation or contracts.
5. Travel may be required to the new counties/States to recruit for network.
6. Supports the Contracting needs of the Provider Network Management department.
7. Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
8. Maintains regular and consistent attendance.
9. Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

1. Takes on special projects as needed.
2. Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

1. Continuous Learning:

a. Attends staff meetings as required.

b. Attends appropriate training, seminars and workshops as required

2. Customer Focus:

a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations and IMAS’s Standards of Conduct.

b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff.

3. Quality/Process Improvement/Safety

a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.

b. Supports and demonstrates safety throughout all duties performed.

c. Follows established policies and procedures and understands and complies with all regulators standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

• High school graduate or equivalent.
• At least 2-3 years prior Health Plan Contracting-Specialists, Hospitals and Primary Care.

SKILLS/KNOWLEDGE/ABILITY:

• Proficient with Microsoft Suite (Word, Excel, etc.)
• Strong phone/customer service skills
• Must be detail orientated.
• Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to members and staff.
• Willingness and ability to follow written and verbal direction in English.
• Willingness and ability to maintain appropriate level of confidentiality and privacy.
• Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
• Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.
• Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
• Ability to effectively prioritize items/tasks as required.
• Willingness and ability to take initiative and be a self-starter.
• Willingness and ability to understand and comply with Federal, State, and local regulations.

LICENSURE/CERTIFICATE/TRAINING:

• n/a