Contract Operations Specialist Senior

Advocate Health; Oak Brook (IL); On-site; USD 110,000 - 150,000; Full time

Job summary

Advocate Health in Illinois seeks a Senior GME Contracts Operations Specialist to lead system-wide medical education contracting, reimbursement, and revenue management. You will oversee affiliation agreements, PLAs, and resident documentation across Advocate sites and training partners.

You will supervise a team of five, ensure compliance with ACGME and CMS rules, analyze financial impact, and collaborate with Legal, Compliance, and Finance to optimize Medicare reimbursements.

Qualifications

• Bachelor's Degree in Health Care Administration or related field.
• Typically requires 5 years of experience in managed care contracting, or insurance networks within a health care environment.
• Strong knowledge of managed care contracting, coding, and reimbursement methodologies.
• Proficiency in Microsoft Office (Excel, Word, Access) is required.
• Excellent analytical, organizational, and communication skills.

Responsibilities

• Serve as system-wide expert for medical education contracting matters and oversee affiliation agreements and PLAs.
• Negotiate, draft, review, and execute: Medical Education Affiliation Agreements, Program Addenda, and Resident Agreements.
• Monitor contract status, renewals, and documentation; oversee annual resident agreement processes.
• Lead IRIS reporting, CAP tracking, and Medicare reimbursement analyses with Finance teams.
• Oversee affiliate billing, invoicing, and revenue management; ensure compliance with regulatory requirements.
• Provide guidance on compliance risks and mitigation strategies to leadership.

Skills

Managed care contracting

Insurance networks

Medical terminology

CPT/ICD/HCPCS coding

Microsoft Office

Analytical skills

Communication skills

Project management

Education

Bachelor's Degree in Health Care Administration or related field

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

Job description

Job Description:

The Graduate Medical Education (GME) Contract Operations Specialist Senior provides system-wide leadership and oversight for medical education contracting, graduate medical education reimbursement, financial reporting, and affiliate billing activities. This role is responsible for the negotiation, development, execution, and compliance management of medical education affiliation agreements supporting residents and fellows across Advocate Health Care sites and external training partners.

In addition, this position directs GME financial operations, including Medicare reimbursement reporting, resident FTE and CAP allocation management, financial impact analyses, and affiliate billing. Serves as the subject matter expert for GME contracts and funding regulations and supervises a team of related support staff (five direct reports).

Major Responsibilities:

Contract Administration and Affiliation Agreements

• Serve as the system-wide expert and primary resource for medical education contracting matters.
• Develop, implement, and maintain policies, procedures, and tracking systems for affiliation agreements, Program Letters of Agreement (PLAs), resident agreements, and related documentation.
• Educate residency programs, teaching sites, and departmental leaders regarding contract requirements, processes, and compliance expectations.
• Negotiate, draft, review, and execute: Medical Education Affiliation Agreements, Program Addenda and Subordinate Agreements, System-wide GME vendor agreements, Resident Agreements and amendments.
• Collaborate with Legal, Compliance, Risk Management, and operational stakeholders to ensure appropriate review and approval of agreements.
• Ensure all agreements comply with applicable regulatory, accreditation, and institutional requirements.
• Review and approve contract amendments, renewals, and modifications.
• Verify that affiliation agreements align with Advocate Health resident CAP allocation strategy and reimbursement requirements.
• Develop and maintain templates for:
  • Program Letters of Agreement (PLAs)
  • PLA amendments
  • Resident Agreements
  • Other standardized educational agreements
• Monitor contract status and completion, ensuring timely execution, renewal, and retention of required documentation.
• Implement and oversee the annual resident agreement process, including distribution, signature collection, tracking, and record maintenance.

Graduate Medical Education Finance and Reimbursement

• Lead preparation, validation, and submission of the annual Intern and Resident Information System (IRIS) report in collaboration with Medicare reimbursement teams.
• Maintain and oversee the resident Full-Time Equivalent (FTE) and CAP tracking database to ensure compliance with organizational policies related to funded and unfunded residency positions.
• Direct the annual aggregate agreement and CAP allocation process across teaching hospitals to maximize Medicare reimbursement opportunities.
• Partner with Finance and Medicare Reimbursement leadership to optimize GME reimbursement and preserve resident CAP positions.
• Conduct financial analyses related to proposed federal and state funding changes affecting graduate medical education programs.
• Monitor, analyze, and report financial performance and reimbursement trends impacting GME operations.
• Develop and implement standardized methodologies for evaluating program costs, funding sources, and return on investment for residency and fellowship programs.
• Provide education and consultation to site and departmental leadership regarding GME funding, reimbursement regulations, and financial implications.

Affiliate Billing and Revenue Management

• Oversee the generation, reconciliation, invoicing, collection and processing of affiliate billing related to visiting residents and educational training agreements.
• Monitor billing processes to ensure accuracy, compliance, and timely revenue collection.
• Identify opportunities to improve billing efficiency and enhance financial reporting.

Regulatory Compliance and Accreditation

• Ensure compliance with all applicable accreditation and regulatory requirements, including Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), Commission on Dental Accreditation (CODA), Council on Podiatric Medical Education (CPME), and Medicare and Medicaid reimbursement regulations
• Monitor regulatory changes and update policies, agreements, and practices accordingly.
• Provide guidance to leadership regarding compliance risks and mitigation strategies.

Additional Responsibilities

• Participate in strategic planning and special projects related to graduate medical education.
• Prepare reports, analyses, and presentations for executive leadership and GME committees.
• Perform other duties as assigned.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• Bachelor's Degree in Health Care Administration or related field.

Experience Required:

• Typically requires 5 years of experience in managed care contracting, or insurance networks within a health care environment.

Knowledge, Skills & Abilities Required:

• Strong working knowledge of managed care contracting, contracting language, insurance networks, and reimbursement methodologies.
• Demonstrated knowledge and understanding of medical terminology, abbreviations, medical codes (CPT, ICD and HCPCS coding), coding conventions and rules established by the AMA, CMS and insurance payment policies.
• Knowledge of various types of medical claims and payment types, claim policies and procedures and provider contract guidelines.
• Intermediate level proficiency in the use of Microsoft Office (Excel, Word and Access) or similar products.
• Excellent analytical, organizational, and problem solving skills.
• Must have excellent verbal and written communication skills to effectively work with payers. Ability to articulate complex claims issues and interacts with various levels within the organization to obtain desired results.
• Strong time management and organizational skills and ability to pay close attention to detail.
• Ability to work independently and with minimal supervision.

Physical Requirements and Working Conditions:

• Must operate all equipment essentials in performing the job.
• This position may require some travel so will be exposed to weather and road conditions.
• Generally exposed to a normal office environment.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.