Contract Specialist - Full Time, Days (Orange) at Prospect Medical Systems - CA in Orange, California

Job Description:

Contract Specialist - Full Time, Days (Orange)

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.

Supports contracting efforts in assigned region for owned and MSO business relationships. Negotiate and draft agreements, amendments, Open Ended Memorandum of Understandings (MOUs), and Patient Specific MOUs. Process, Load, and maintain contracts and providers in contracting database application. Acts as liaison with various internal departments to facilitate and resolve claims, provider configuration, customer service, credentialing, and other related issues.

Job Responsibilities/Duties

• Negotiate and draft agreements and amendments outlining contractual terms as directed.
• Engage in specialty provider recruitment efforts to support network adequacy requirements.
• Present contracts and amendments for execution.
• Draft provider terminations and other provider correspondences.
• Initiate Alerts for adds, terms, and changes to internal departments for claims and referral system updates, health plan submissions, and member outreach as needed.
• Load agreements and providers to contracting data application with all contractual terms and linkages.
• Manage Claims Inquiries email box and Referral Queue.
• Negotiate MOUs as needed for referrals to non-contracted providers and secure savings for non-contracted claims.
• Provide clarification on contractual arrangements to internal departments, providers and billing companies.
• Provides customer service to network providers and other internal departments by responding to contracting inquiries, claims questions, and credentialing inquiries, and provider configuration.
• Follow up for return of signed contracts, amendments, credentialing applications, and attestations.
• Works with credentialing department as needed to obtain credentialing and re-credentialing documents.
• Provides administrative support to Contract Administrator and Contract Manager.
• Generate reports as requested and other duties as assigned
• Track and document tasks to completion

Minimum Education: Associates degree or equivalent education and experience preferred.

Minimum Experience: Three (3) years contract negotiations in a managed care environment working with Medicare and Medicaid fee schedules required. Knowledgeable of Commercial, Medicare, Medicaid lines of business required.Maintain confidentiality and adhere to all regulatory requirements as well as to policies and procedures.

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, benefit eligible positions will receive:

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

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://www.eeoc.gov/