Payer Strategy Physician Contract Specialist

CommonSpirit Health Philanthropy; Rancho Cordova (CA); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player seeks a Contract Specialist to support negotiation strategies for Managed Care payer contracts. This remote role focuses on ensuring compliance with standards while working closely with various teams to manage contract proposals and documentation. The ideal candidate will have a strong background in physician contract negotiation and a solid understanding of managed care operations. Join a compassionate organization committed to improving community health through effective contract management and negotiation practices. If you are detail-oriented and possess excellent communication skills, this opportunity is perfect for you.

Qualifications

• 1-2 Jahre Erfahrung in der Verhandlung von Arztverträgen erforderlich.
• Kenntnisse in der Erstattung der finanziellen Aspekte von Verträgen und Managed Care.

Responsibilities

• Überprüfung und Anpassung von Vertragsvorschlägen zur Gewährleistung von Genauigkeit.
• Koordination mit Division PSR-Teams zur Unterstützung der Credentialing-Prozesse.

Skills

Verhandlungskompetenz

Projektmanagementfähigkeiten

Schriftliche Kommunikation

Mündliche Kommunikation

Kenntnisse in Vertragswesen

Education

High School Diploma

Bachelor's Degree in related discipline

Tools

Microsoft Suite

Google Suite

Job description

Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsibilities

This is a remote position with a strong preference for the person to live in California and have California physician contract experience.

Job Summary:

The Contract Specialist Divisional Payers Payer Strategy & Relationships (PSR) works closely with Divisional Payers, the Payer Relations Manager, Divisional Directors, National PSR team, and the PSR Analytics & Innovation team to support the negotiation of terms and conditions for Managed Care payer contracts for facility, professional, and ancillary entities. Primary focus of contracting and negotiation support is to ensure the terms and conditions of the payer contract adhere to the CSH Standards and Guidelines, represent industry best practices for Fee for Service and value-based arrangements, and align with operational objectives.

Job Responsibilities:

1. Review and redline contract proposals, language, and rate sheets to ensure accuracy, completeness, and compliance with CommonSpirit Health standards and guidelines.
2. Recommend corrections, changes, and any language opportunities in documents to Director.
3. Assist Director with updating project plan documents, meeting minutes, and action item follow-up related to Divisional Payers renewals and planning.
4. Ensure that all amendments, letters of agreement (LOA), memorandum of understanding (MOU), and other contract documents are signed by the appropriate parties and provide the fully executed contract documents to the Contract Administration team.
5. Coordinate with Division PSR teams as needed to facilitate credentialing and re-credentialing of CSH entities.
6. Maintain complete and up-to-date inventory of all CSH hospitals/specialty hospitals to include demographic information, license, NPI, Tax ID information, etc.
7. Assist in communicating and operationalizing contract terms, amendments, and policy terms.
8. Maintain Divisional Payer knowledge base to include financial statements/reports, news articles, and other information.
9. Adhere to all established contracting guidelines. Contracting accountability for negotiation support includes hospital, physician, and ancillary services.

Qualifications

Minimum Qualifications:

• Education - High school diploma required. Bachelor’s Degree in related discipline or equivalent work experience.
• Experience - One (1) to two (2) years physician contract negotiation experience is required. Three (3) to five (5) years experience preferred.
• Skills, Knowledge, and Abilities - This position requires knowledge and experience in reimbursement of the financial aspects of contracting and managed care operations.
• Additionally, effective negotiation skills, project management skills, excellent written and verbal communication skills, and expertise and experience with Microsoft/Google Suite (Excel/Word) are required.