Contracting Specialist

MCS Puerto Rico; San Juan (PR); On-site; USD 60,000 - 90,000; Full time

Job summary

MCS Puerto Rico is seeking a Contracts Specialist to execute processes for contracting professional service providers and coordinating negotiations. You will perform market analysis to ensure policy and regulatory compliance and manage contract submissions and renewals.

Responsibilities include preparing agreements, gathering market data, obtaining approvals, and maintaining provider relationships across business lines in a Puerto Rico context.

Qualifications

• Bachelor's degree in Health Services Administration, Business Administration or health-related areas.
• At least three (3) years of experience in negotiation strategies, reporting, contracting, or provider services in Healthcare Insurance preferred.

Responsibilities

• Ensures rates in contracts are approved after economic impact analysis.
• Collects market information and historical data to analyze and create provider contracts.
• Submits contracts for management review before provider contact.
• Maintains strong business relationships with providers and ensures understanding of contract terms.
• Sends final contract for provider signature and renewal documentation.
• Follows up on new and renewal contracts with credentialing and System Configuration.
• Ensures terms align with billing guides and reduce manual interventions.
• Coordinates with other departments to resolve high-complexity issues.

Skills

Negotiation

Market analysis

Contract management

Stakeholder communication

Regulatory compliance

Education

Bachelor's degree in Health Services Administration/Business Administration or health-related fields

Job description

GENERAL DESCRIPTION

Responsible for executing processes related to contracting professional service providers, which includes conducting market analysis to ensure compliance with the contracting policy and regulatory standards. Coordinate visits, negotiate agreements, and manage contracts for providers and the company's business lines.

Regular
Exempt

ESSENTIAL FUNCTIONS

• Ensures that the rates to be included in the contract receive approval after being evaluated through an economic impact analysis.
• Collects market information and historical data to analyze, discuss, and create Provider contracts following the legal requirements by the type of service.
• Submits the contracts for review and approval to the management before submitting them to the Providers to be contacted.
• Ensures a strong business relationship with the Provider, making sure the client acknowledges the contract's structure, agreements, specifications, and previous resolutions, among other related details.
• Responsible for sending the final contract for the signature of the provider (initial documentation and/or renewal).
• Follows up on new and subsequent contracts from credentialing to the System Configuration department, as required.
• Maintains continuity in registering internal and external assigned requests and provides the necessary follow-up to respond to these requests in the established time.
• Ensure that the negotiated terms can be correctly configured and managed. Confirm that terms are compatible with the billing guides and operational procedures. Assure the terms align with the automation and reduction of manual interventions.
• Prepares Letters of Agreement, follows up, and confirms the necessary approvals are obtained for cases of services not contracted inside and outside Puerto Rico within the established time as the approved Policies and Procedures.
• Collaborate with other departments to resolve situations of high complexity and scale sensitive issues to the appropriate levels of management.
• Coordinates meetings with other departments and supports administrative duties, such as assisting with the handling of reporting requests, queries, and potential risks identified, and escalating to management for immediate resolution.

ADDITIONAL FUNCTIONS

• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS

Education and Experience: Bachelor's degree in Health Services Administration, Business Administration, or health-related areas. At least three (3) years of experience in negotiation strategies, reporting,
contracting, or provider services in the Healthcare Insurance industry is preferred.

“Proven Experience May Be Replaced By Previously Establishedrequirements.”

Certifications / Licenses: N/A

Other: N/A

Languages

Spanish – Intermediate (comprehensive, writing and verbal)

English – Intermediate (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take Aff…. ”