Managed Care Contract Specialist

Location

Englewood, CO | United States

Job description

Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

This is a remote position within the US. This position will work with work managed care payers in the Midwest region. Strong preference for Midwest location. 

Works closely with the Contract Manager and other Managed Care leadership, to support the negotiation of terms and conditions for Managed Care payer contracts for facility, professional, and ancillary entities. Primary focus of contracting and negotiation support is to ensure the terms and conditions of the payer contract adhere to the CommonSpirit Health Standards and Guidelines, represent industry best practices for Fee for Service and value-based arrangements, and align with operational objectives  

Essential Key Job Responsibilities

• Supports the review of contract proposals, language and rate sheets to ensure accuracy, completeness and in compliance with CommonSpirit Health standards and guidelines.
• Recommends corrections, changes and any language opportunities in documents to PSR leadership
• Assists PSR leadership with developing and updating project plan documents, meeting minutes and action item follow up related to National Payers renewals and planning.
• Ensures all amendments, letters of agreement (LOA), memorandum of understanding (MOU) and other contract documents are signed by the appropriate parties and provide the fully executed contract documents to the Contract Administration team.
• Ensures contract documents include rate escalators and obtain updated rate tables fee schedules and all contracting materials are stored according to PSR and/or Legal Policies, and ensures information is made available to or disseminated to key stakeholders of the negotiation process.
• Coordinates with other PSR team members to facilitate credentialing and re-credentialing of CSH entities.
• Maintains complete and up to date inventory of all CSH hospitals/specialty hospitals to include demographic information, license, NPI, Tax ID information, etc.
• Assists in communicating and operationalizing contract terms, amendments, and policy terms.
• Maintains National Payer knowledge base to include financial statements/reports, news articles and other information.
• Adheres to all established contracting guidelines. Contracting accountability for negotiation support include hospital, physician, and ancillary services.

• Bachelor’s degree or equivalent education and experience
• Minimum of three (3) years’ contract negotiation or contract experience in a healthcare related field
• Healthcare experience strongly preferred

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