Contract Configuration Specialist

Job Description

• Create and maintain custom fee schedules, vendor contracts and capitation based on contract terms.
• Create provider and facility contracts and terms in multiple systems.
• Facilitate the resolution of escalated configuration issues, including liaise between process and technical disputes.
• Act as Point of Contact for team and business partners to discuss process improvement opportunities. Accountable for ownership and resolution of these opportunities.
• Collaborate with Product Owners to ensure that Provider/Contract Configuration solutions and deliverables are met as agreed.
• Maintains excellent, proactive, and transparent communication with leaders, stakeholders, including IT and other business partners to ensure deliverables are met.
  
  

Responsibilities for Internal Candidates

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.

Qualifications For Internal Candidates

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.High school diploma or GED Associates degree

Responsibilities

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.

Qualifications

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.High school diploma or GEDAssociates degree