Value Based Senior Specialist - Provider Contracting - Paramount - Full Time - Days
The Value Based Senior Specialist performs work associated with provider contracting services within the Paramount network. This position works closely with department staff and ProMedica Legal Department to produce standard and non-standard agreements as necessary. This position also assures that all requirements of standard and non-standard contracts are fulfilled and monitored. Also ensures that all contract boilerplates meet regulatory and compliance standards for Ohio, Michigan and any other applicable states.
- Prepares and maintains provider contracts. Revises provider contracts as required by local, state, and federal rules and regulations, and Health Plan changes.
- Ensures all terms, including financial terms are administered as required throughout the term of the contracts. Works closely with department staff to design and maintain reports to assure compliance.
- Negotiates reimbursement rates and contract terms and conditions with providers, consistent with management direction. Negotiates modifications to existing contracts.
- Coordinates and/or develops both internal and external communication regarding provider contracting and reimbursement.
- Serves as a resource on policies and procedures related to provider contracting and reimbursement.
- Responsible for accurate documentation of all contractual terms for each agreement.
- Cooperates as needed interdepartmentally as well as intradepartmental, and performs other duties as assigned.
- Assists with training staff on new regulatory and compliance boilerplate language.
- Assist with representing department in steering committees, joint operating committees, and with NCQA/Regulatory/Compliance meetings.
- Assist department leadership with coordinating and operationalizing staff bi-weekly or monthly meetings.
- Other duties as assigned.
Education: Bachelor’s degree required (Master’s degree preferred) in health care administration, health care related field with minimum of 5+ years experience interacting with providers and/or their staff in a management, contracting, or liaison role required.
Skills: Advanced working knowledge of contracting methods and contract negotiation techniques.
- Advanced understanding of provider reimbursement methods regarding professional and facility services. Including advanced knowledge of CPT/HCPCS , EAPG, APC, Revenue Codes, SNF levels of care, and ASC reimbursement mythology.
- Prefer advanced knowledge of claims processing, medical terminology, medical billing, and basic coding methods.
- Demonstrate extensive planning, organizational and problem solving skills required, with the ability to handle multiple tasks.
- 5+ years past experience with analytical methods is required .
- Excellent communication (oral and written) skills required.
- Strong facilitation skills required.
- Proficient in use of computers and Microsoft Office applications Excel, Word, and Outlook. Knowledge of Microsoft Access and Power Point is a plus. Knowledge of AMISYS , CACTUS, Cognos, IBM/Truven Analytics, and ChangeHealth Contracting Management software is a plus.
- Ability to move between company workstations and departments required.
- Valid driver’s license and ability to travel independently through Health Plan’s service area required. This job requires consistent travel to statewide meetings/forums.
Years of Experience: 5+
Skills: see above
Years of Experience: 7+
Personal Protective Equipment:
Physical Demands: Ability to move between company workstations and departments required. Valid driver’s license and ability to travel independently through Health Plan’s service area required. This job requires consistent travel to statewide meetings/forums.
The above list of accountabilities is intended to describe the general nature and level of work performed by the incumbent; it should not be considered exhaustive.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
EOE/M/F/D/V Drug-Free Workplace
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