Supervisor de Contratacion

MCS Health; San Juan (PR); On-site; USD 70,000 - 90,000; Full time

Job summary

MCS Health is seeking a Contracting Operations Manager to administer and oversee the provider network contracting area in Puerto Rico, ensuring compliance with policies and regulations. You will monitor contracting requests, develop procedures, supervise staff, and coordinate with management to align actions with company goals.

Travel to various locations in Puerto Rico and maintain digitized contracts and communications.

Qualifications

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Responsibilities

• Oversee end-to-end provider contracting operations to ensure compliance with policies and regulations.
• Develop and maintain updated policies and procedures for the contracting unit.
• Monitor trends in contracting requests and prepare management presentations.
• Evaluate provider networks by specialty and geography to ensure access to services across lines of business.
• Address provider rate increase requests with documented solutions and maintain records.
• Ensure timely distribution of welcome letters and contracts to new providers and digitize all communications.
• Supervise and develop staff, ensuring adherence to company policies and procedures.
• Support internal and external audits with requested information.

Skills

Microsoft Office

Outlook

Excel

Word

PowerPoint

Contracting principles

Education

Bachelor's in Health Admin

Tools

None

Job description

Administers, manages, and monitors the operation of the Contracting area to guarantee compliance with organizational goals, following the applicable regulations for each line of business and the contracting and credentialing policy. Oversee the operation and experience of contracting end-to-end Providers and determine if inventory action plans are necessary.

ESSENTIAL FUNCTIONS:

• Continuously monitors trends in provider contracting requests and prepares presentations for discussion with management.
• Develops and maintains updated policies and procedures for the contracting unit, ensuring compliance with laws and regulations relevant to each line of business.
• Implements necessary actions to ensure alignment with the goals and objectives of the unit, including the adequacy goals of the Provider Network.
• Evaluates and monitors provider networks by specialty and geographic area to guarantee access to all services covered by our products across all lines of business. Additionally, makes recommendations regarding the inclusion or elimination of medical specialties, as recognized by established agencies and accrediting boards, including recommendations concerning the pricing system.
• Addresses requests for rate increases from providers, provides solutions, and keeps detailed records of all related documentation.
• Establish monitoring mechanisms to ensure that the welcome letter and a copy of the contract are sent promptly to newly contracted providers.
• Ensure that all provider contracts and communications are properly digitized in the system.
• Supervises the team in continuously evaluating and monitoring the provider network contracting process, defining mechanisms to ensure that information in the systems and provider files is current, and that established timeframes are adhered to.
• Evaluates and analyzes production reports related to the quality of the initial contracting process and the maintenance of provider network contracts.
• Identifies, establishes, and monitors controls to ensure the quality of department processes and implements necessary corrective actions when needed.
• Manage special initiatives assigned based on operational needs.
• Ensures that requested information for both internal and external audits is provided promptly.
• Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave according to the policies, standards, norms, and procedures of the Company.
• 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 four (4) years of experience in areas related to the healthcare provider network, contract administration, or similar functions in the Health Insurance Industry is preferred. At least one (1) year of experience supervising staff.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses:

A valid driver’s license in the Commonwealth of Puerto Rico is required.

Other:

Car in good condition and available to travel to different locations in Puerto Rico. Knowledge of the regulations applicable to the Medical Plans Industry. Intermediate knowledge of Microsoft Office Suite applications such as Outlook, Excel, Word, and PowerPoint (ability to process files, filters, and sort data). Knowledge of contracting principles and practices such as contract law, procurement regulations, and best practices.

Languages:

• Spanish – Intermediate (comprehensive, writing and verbal)
• English – Intermediate (comprehensive, writing and verbal)

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

MCS Healthcare Holdings, LLC. (MCS)is an Equal Employment Opportunity Employer and take Aff 𝑘….