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Contract Administrator in Orange at Prospect Medical Systems

Date Posted: 10/16/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/16/2018
  • Job ID:
    10871

Job Description



Contract Administrator

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Contract Administrator is responsible for sustaining and building network(s) with full panel of Primary Care and Specialists for Prospect and MSO clients. Identify network needs and negotiate Memorandums of Understanding (MOUs) and contracts with providers to ensure availability and accessibility to members. Produce contract documents (fee for service agreements, full risk agreements, capitation agreements, (MOUs) and ensure timely turn around. Negotiate stat contracts with non-contracted providers when needed.



Job Responsibilities/Duties

  • Maintains networks by reviewing provider panels and identifying network needs, fills network gaps by negotiating cost effective contracts with providers. Reviews and approves all newly drafted contracts and amendments to ensure they are within company standards on profitability and documents all cost savings on the monthly Cost Savings report.
  • Follows up for return of signed contracts and amendments. Works with credentialing department as needed to obtain credentialing documents, upon completion of credentialing process presents contracts for execution.
  • Upon termination of existing providers, reviews network to ensure there are other contracted providers in the same service category, ensures a termination acknowledgement letter is sent, if needed, negotiates contract with new provider.
  • Reviews CDA to ensure executed contracts and amendments are accurately entered.
  • Ensures contract summaries filed on the K drive contain accurate contract information.
  • Reviews and approves all letters to network providers that have been prepared by support staff.
  • Initiates or creates electronic change forms for new agreements, terminations, demographic changes, and new tax identification numbers.
  • Provides customer service to network providers by responding to contracting inquiries, requests for reimbursement increases, claim questions, credentialing issues.
  • Prepares and submits requests for financial analysis to finance department in preparation for negotiating new capitated contracts or when renegotiating existing contracts.
  • As needed negotiates MOUs urgent requests from Medical Management, Provider
  • Dispute Resolutions and Member balance bill issues. Ensures follow up for signed documents is completed, MOUs are entered in CDA, and electronic change forms are created for executed MOUs.
  • Provides customer service for internal inquiries by providing clarity on contractual arrangements and reimbursement structures.
  • Reviews weekly CDA reports to ensure contracts are accurately loaded and turnaround times are being met.
  • Completes and/or oversees special projects, mass amendments and other assignments as needed or as assigned.


Qualifications

Minimum Education: Four (4) year college degree required.

Minimum Experience: Three (3) years of contracting experience related to healthcare or equivalent experience in a healthcare setting relative to the functions and duties of this position. Contract negotiation experience required. 

Req. Certification/Licensure: None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm



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