Contracts Coordinator II - Managed Care in Ontario, CA at Prime Healthcare

Date Posted: 2/4/2020

Job Snapshot

Job Description

Overview
The Health Plan Operations Contract Coordinator II is responsible for assisting in the management, security, and data integrity of the managed care agreements in place for all Prime Healthcare provider entities; is the primary staff person to maintain the physical/original and electronic managed care contract files; tracks and monitors contracts throughout procurement process; updates and distributes rate matrixes.  The Contract Coordinator II must effectively interact with Executive, Hospital and Business Office Management, and Support Staff.  The position also performs special projects as assigned by the Department Management; requires a high level of responsibility, confidentiality, judgment and discretion in applying departmental policies and procedures and handling confidential information; works independently requiring minimal direction.
 
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Responsibilities

Requires a working knowledge of managed care contracts (language vs. rates; active vs. terminated; insurance products).
Requires a working knowledge of the hospital credentialing process required by Managed Care Payors.
Requires a high degree of organization, follow-up, and task management using independent judgment.
Prepares and maintains status grids of contracts, reimbursement rates, and projects for the Department. Is able to independently identify inter-relationships and makes changes in files, spreadsheets and support applications.
Sorts logs and distributes all incoming mail/ contracts and identifies mail that needs immediate attention.
Able to organize and prioritize duties on a daily, weekly and monthly basis.
 
Contractor Support

  • Utilizes the contract management application to actively manage all current Managed Care contracts for the Prime Healthcare Services Hospitals.
  • Loads and updates the Application with changes/ corrections to contracts, amendments and contract termination letters.
  • Identify and make recommendations to improve the Contract process requirements to further streamline the contract management process.

     
    Respond to Requests from Contracted Payers

    • Obtain, maintain and provide current credentials for all Prime Facilities and/or for Ancillary Services as requested by all contracted Health Plans.
    • Identify, develop and maintain relationships with the administrative and support staff and at each Prime facility in order to obtain and respond to credentialing requests.
    • Respond to Health Plan requests within reasonable time periods.

       
      Contract Coordination: Physical File Contract Maintenance

      • Maintain an organized, efficient filing system comprised of several thousand.
      • Managed Care Contract files for all Prime Healthcare Facilities and Medical Groups/Clinics.
      • Identify and make recommendations to improve the Contract maintenance process further streamline departmental processes.
      • Scan, copy and prepare the following types of contracts/letters for return to the Payer via FedEx: Partially executed contracts, fully executed agreements or Termination letters.
      • File original contracts in Hospital’s physical and electronic contract file.
      • Maintains department contract negotiation working files.
      • Update a Log to track the return of signed contracts.
      • Ensures that all managed care contracts and documents are kept secure and all information is confidential.
      • Assist other Departments or Hospital Business Offices to resolve questions with contracts.

        Qualifications

        Required qualifications:
      • High School Graduate
      • Effective 02/01/2020 Minimum 3 year’ experience in physician/vendor contracts required
      • Computer literate with an intermediate knowledge base of Microsoft Excel, Word, Outlook. Strong grammar and communication skills.
      • Strong organizational and follow-up skills
      • Ability to interact at a professional level.
         
        Preferred qualifications:
      • Effective 02/01/2020 Minimum 3 year’ experience in physician/vendor contracts required
      • General familiarity with hospital and professional billing guidelines, Medicare guidelines, and Managed Care contracts.
      • SharePoint knowledge. 
        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. EEO is the Law: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf