Payer Strategy Physician Contract Specialist

CommonSpirit Health; San Francisco (CA); Remote; USD 65,000 - 90,000; Full time

Job summary

CommonSpirit Health seeks a Contract Specialist for Divisional Payers to support contract terms negotiation. Candidates will work closely with various teams to ensure adherence to standards and promote effective contract management processes within the organization. Experience in contract negotiation and familiarity with healthcare reimbursement is essential for success in this remote role, particularly for those residing in California.

Qualifications

• 1-2 years experience in physician contract negotiation required.
• Knowledge in reimbursement and managed care operations essential.
• Effective negotiation and project management skills needed.

Responsibilities

• Review and redline contract proposals for adherence to standards.
• Assist in updating project plans and action items.
• Maintain complete inventory of CSH hospitals and demographic data.

Skills

Negotiation skills

Project management

Communication skills

Education

Bachelor's Degree in related discipline

Tools

Microsoft Suite

Google Suite

Job description

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 :

• Review and redline contract proposals language and rate sheets to ensure accuracy completeness and in compliance with CommonSpirit Health standards and guidelines.
• Recommend corrections changes and any language opportunities in documents to Director.
• Assist Director with updating project plan documents meeting minutes and action item follow up related to Divisional Payers renewals and planning.
• 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.
• Coordinate with Division PSR teams as needed to facilitate credentialing and re-credentialing of CSH entities.
• Maintains complete and up to date inventory of all CSH hospitals / specialty hospitals to include demographic information license NPI Tax ID information etc.
• Assist in communicating and operationalizing contract terms amendments and policy terms.
• Maintain Divisional Payer knowledge base to include financial statements / reports news articles and other information.
• Adhere to all established contracting guidelines. Contracting accountability for negotiation support include 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.

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Physician Contract • San Francisco, CA, United States