CareOregon
Senior Contract Specialist
CareOregon, Medford, Oregon, United States, 97504
Career Opportunities: Senior Contract Specialist (24625)
Requisition ID
24625
- Posted
10/21/2024
-
CareOregon
-
Full Time - Permanent
-
Portland
- Multi Location (18)
Job Description Print Preview
Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.
Job Title
Senior Contract Specialist
Exemption Status
Exempt
Department
Contract Management
Manager Title
Value Based Contract Manager
Direct Reports
n/a
Requisition #
24625
Pay and Benefits
Estimated hiring range $88,430 - $108,080 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits
Posting Notes
This is a fully remote role, but you must reside in one of the listed 9 states.
Job Summary
The Senior Contract Specialist is a key contributor to the Contracting team. This position negotiates, develops, and maintains Letters of Agreements (LOAs), and healthcare services contracts which are moderately advanced to complex in nature; may also be responsible for Single Case Agreements (SCA), as assigned. Primary areas of focus include hospital systems and contracts with custom terms. This position also provides analytical, programmatic and project leadership for the department and serves as a resource throughout company for contract language and terms. This position maintains positive, effective relationships with contracted provider network with attention to ongoing service needs, as well as maintains effective relationships with internal departments impacted by contract changes. The Senior Contract Specialist identifies expense outliers, performs financial analysis, and recommends reimbursement strategies.
Essential Responsibilities
Contract and LOA Negotiation and Development
Manage internal contracting process, LOA, and external network relationships for assigned providers and programs.
Negotiate contract language and terms.
Negotiate, coordinate, and produce Letters of Agreement and other provider contract documents.
Build, maintain and leverage effective working relationships with external and internal constituents.
Financial Analysis and Reporting
Perform and review financial analysis with Contract department leadership, Contracting leadership of assigned area and Finance staff.
Perform advanced data gathering, analysis, and reporting in alignment with Contracting policies and procedures.
Lead the development and analysis for key programs and provide recommendations based on analysis.
Assist with the compilation of mandated reporting regarding contract payments.
Contract Administration
Oversee the tracking and monitoring of contracts, LOAs, and related metrics; may also be responsible for SCAs.
Ensure payments are made based on contract terms and assist with the facilitation of those payments as needed.
Ensure all necessary contract information is directed to Provider Services staff for provider data file entry and maintenance.
Assist in the resolution of provider issues related to contractual relationships.
Coordinate accuracy and maintenance of provider payment networks with System Coordinators.
Project Leadership
Provide program and advanced project leadership for assigned area to the Contracting department.
Collaborate with internal departments and leadership to determine appropriate changes to existing programs; participate in the design of new programs and payment models.
Create programmatic materials that educate the provider network and internal teams regarding changes to existing and new payment models.
Department Policies and Operations
Play a critical role in developing and maintaining contract infrastructure and procedures based on management direction.
Recommend provider payment and network strategies to the contract management team.
Orient CareOregon staff to contracting process; act as an advanced resource to staff on contract-related matters.
Organizational Responsibilities
Perform work in alignment with the organization's mission, vision and values.
Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization's strategic goals.
Adhere to the organization's policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Experience and/or Education
Required
Minimum 5 years' progressive experience in managed care contracting, provider relations, network/business development, or financial analysis/accounting with a minimum of 2 years in contract negotiation, development, and administration
Preferred
Bachelor's degree in Business, Health Care Administration, Analytics, or related degree
Knowledge, Skills and Abilities Required
Knowledge
Extensive knowledge of managed care and the Oregon Health Plan
Strong knowledge of federal Medicare regulations and state Medicaid rules (OARs)
Knowledge of claims administration and ability to implement contract reimbursement terms
Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), shared savings agreements, and ability to perform rate calculations
Strong knowledge of data analytics tools and methodologies
Knowledge of physician group, hospital, and facility operations
Skills and Abilities
Excellent analytical skills
Excellent written and verbal communication skills
Strong word processing, spreadsheet, and database skills
Ability to negotiate facility contract language and terms
Ability to develop and maintain effective relationships with providers and provider groups
Ability to achieve desired outcomes through effective use of negotiation skills
Ability to negotiate and implement complex reimbursement arrangements
Ability to maintain professional relationships with internal staff and departments
Ability to independently work with providers, provider groups and other populations in addressing and resolving problems
Ability to work independently, organize, prioritize, and manage multiple projects
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure
Member/Patient Facing: No Telephonic In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.
#Li-Remote
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.
Veterans are strongly encouraged to apply.
We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.
Visa sponsorship is not available at this time.
Requisition ID
24625
- Posted
10/21/2024
-
CareOregon
-
Full Time - Permanent
-
Portland
- Multi Location (18)
Job Description Print Preview
Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.
Job Title
Senior Contract Specialist
Exemption Status
Exempt
Department
Contract Management
Manager Title
Value Based Contract Manager
Direct Reports
n/a
Requisition #
24625
Pay and Benefits
Estimated hiring range $88,430 - $108,080 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits
Posting Notes
This is a fully remote role, but you must reside in one of the listed 9 states.
Job Summary
The Senior Contract Specialist is a key contributor to the Contracting team. This position negotiates, develops, and maintains Letters of Agreements (LOAs), and healthcare services contracts which are moderately advanced to complex in nature; may also be responsible for Single Case Agreements (SCA), as assigned. Primary areas of focus include hospital systems and contracts with custom terms. This position also provides analytical, programmatic and project leadership for the department and serves as a resource throughout company for contract language and terms. This position maintains positive, effective relationships with contracted provider network with attention to ongoing service needs, as well as maintains effective relationships with internal departments impacted by contract changes. The Senior Contract Specialist identifies expense outliers, performs financial analysis, and recommends reimbursement strategies.
Essential Responsibilities
Contract and LOA Negotiation and Development
Manage internal contracting process, LOA, and external network relationships for assigned providers and programs.
Negotiate contract language and terms.
Negotiate, coordinate, and produce Letters of Agreement and other provider contract documents.
Build, maintain and leverage effective working relationships with external and internal constituents.
Financial Analysis and Reporting
Perform and review financial analysis with Contract department leadership, Contracting leadership of assigned area and Finance staff.
Perform advanced data gathering, analysis, and reporting in alignment with Contracting policies and procedures.
Lead the development and analysis for key programs and provide recommendations based on analysis.
Assist with the compilation of mandated reporting regarding contract payments.
Contract Administration
Oversee the tracking and monitoring of contracts, LOAs, and related metrics; may also be responsible for SCAs.
Ensure payments are made based on contract terms and assist with the facilitation of those payments as needed.
Ensure all necessary contract information is directed to Provider Services staff for provider data file entry and maintenance.
Assist in the resolution of provider issues related to contractual relationships.
Coordinate accuracy and maintenance of provider payment networks with System Coordinators.
Project Leadership
Provide program and advanced project leadership for assigned area to the Contracting department.
Collaborate with internal departments and leadership to determine appropriate changes to existing programs; participate in the design of new programs and payment models.
Create programmatic materials that educate the provider network and internal teams regarding changes to existing and new payment models.
Department Policies and Operations
Play a critical role in developing and maintaining contract infrastructure and procedures based on management direction.
Recommend provider payment and network strategies to the contract management team.
Orient CareOregon staff to contracting process; act as an advanced resource to staff on contract-related matters.
Organizational Responsibilities
Perform work in alignment with the organization's mission, vision and values.
Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization's strategic goals.
Adhere to the organization's policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Experience and/or Education
Required
Minimum 5 years' progressive experience in managed care contracting, provider relations, network/business development, or financial analysis/accounting with a minimum of 2 years in contract negotiation, development, and administration
Preferred
Bachelor's degree in Business, Health Care Administration, Analytics, or related degree
Knowledge, Skills and Abilities Required
Knowledge
Extensive knowledge of managed care and the Oregon Health Plan
Strong knowledge of federal Medicare regulations and state Medicaid rules (OARs)
Knowledge of claims administration and ability to implement contract reimbursement terms
Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), shared savings agreements, and ability to perform rate calculations
Strong knowledge of data analytics tools and methodologies
Knowledge of physician group, hospital, and facility operations
Skills and Abilities
Excellent analytical skills
Excellent written and verbal communication skills
Strong word processing, spreadsheet, and database skills
Ability to negotiate facility contract language and terms
Ability to develop and maintain effective relationships with providers and provider groups
Ability to achieve desired outcomes through effective use of negotiation skills
Ability to negotiate and implement complex reimbursement arrangements
Ability to maintain professional relationships with internal staff and departments
Ability to independently work with providers, provider groups and other populations in addressing and resolving problems
Ability to work independently, organize, prioritize, and manage multiple projects
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure
Member/Patient Facing: No Telephonic In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.
#Li-Remote
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.
Veterans are strongly encouraged to apply.
We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.
Visa sponsorship is not available at this time.