Contract Configuration Specialist

Prospect Medical Systems; Orange (CA); On-site; Full time

Job summary

A leading healthcare organization is seeking a Contract Configuration Specialist to manage vendor contracts and fee schedules. This role involves negotiating agreements, ensuring compliance with Medicare and Medicaid regulations, and providing administrative support. Ideal candidates will have experience in managed care and strong communication skills.

Qualifications

• Three years of contract negotiations in a managed care environment.
• Knowledge of Medicare and Medicaid fee schedules required.
• Maintain confidentiality and adhere to regulatory requirements.

Responsibilities

• Negotiate and draft agreements and amendments outlining contractual terms.
• Engage in specialty provider recruitment efforts.
• Provide customer service to network providers and respond to inquiries.

Skills

Contract Negotiations

Communication

Customer Service

Education

High school diploma or GED

Associates degree preferred

Job description

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Prospect Medical Systems provided pay range

This range is provided by Prospect Medical Systems. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$27.76/yr - $35.63/yr

Job Description

Create and maintain custom fee schedules, vendor contracts, and capitation based on contract terms. Create provider and facility contracts and terms in multiple systems. Facilitate the resolution of escalated configuration issues, including liaising between process and technical disputes. Be accountable for ownership and resolution of these opportunities. Collaborate with Product Owners to ensure that Provider/Contract Configuration solutions and deliverables are met as agreed. Maintain excellent, proactive, and transparent communication with leaders, stakeholders, including IT and other business partners to ensure deliverables are met. Test contract configuration and claims adjudication according to contract terms to ensure accuracy across platforms.

Responsibilities

• Negotiate and draft agreements and amendments outlining contractual terms as directed.
• Engage in specialty provider recruitment efforts to support network adequacy requirements.
• Present contracts and amendments for execution.
• Draft provider terminations and other provider correspondences. Initiate alerts for adds, terms, and changes to internal departments for claims and referral system updates, health plan submissions, and member outreach as needed.
• Load agreements and providers to contracting data application with all contractual terms and linkages.
• Manage Claims Inquiries email box and Referral Queue.
• Negotiate MOUs as needed for referrals to non-contracted providers and secure savings for non-contracted claims.
• Provide clarification on contractual arrangements to internal departments, providers, and billing companies.
• Provide customer service to network providers and other internal departments by responding to contracting inquiries, claims questions, and credentialing inquiries, and provider configuration.
• Follow up for return of signed contracts, amendments, credentialing applications, and attestations.
• Work with credentialing department as needed to obtain credentialing and re-credentialing documents.
• Provide administrative support to Contract Administrator and Contract Manager.
• Generate reports as requested and track/document tasks to completion.

Qualifications

Three (3) years of contract negotiations in a managed care environment working with Medicare and Medicaid fee schedules required. Knowledge of Commercial, Medicare, Medicaid lines of business required. Maintain confidentiality and adhere to all regulatory requirements as well as to policies and procedures. High school diploma or GED; Associates degree preferred.