Provider Contracts Administrator

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Job description

Advanced Health is a locally owned and operated Coordinated Care Organization (CCO) serving all Coos and Curry County communities. We are searching for collaborative, innovative people committed to a shared community vision for health to join our team. We are currently hiring a Contracts Administrator! If you are detail-oriented, organized, skilled in contract administration, negotiation, and value being part of a team that makes a difference, you may be the right person for the position! Apply today!
We are committed to offering competitive wages and benefits, including: Paid Time Off (PTO), sick leave, health and life insurance, 401(k) retirement and other great benefits alongside a team-oriented atmosphere that values each of our employees as an individual and their work-life balance.
Every employee shares the responsibility for achieving the Quadruple Aim of health care reform: member engagement and satisfaction, improving quality of care, managing costs, and honoring diversity and equity. By focusing on the people and communities we serve, we strive to ensure the dignity, privacy and confidentiality of members, their families, co-workers, and others. All duties are performed in compliance with organization's policies and procedure, contractual obligations, and within federal and state laws and guideline including HIPAA, OSHA, and Waste Fraud and Abuse regulations.
JOB PURPOSE:
This position is responsible for the organization's contract and value-based payment programs and includes preparation, negotiation, monitoring, reviewing, and updating provider contracts. This position is responsible for building and maintaining business partnerships, adhering to all contractual requirements and obligations, and meeting strategic goals. This position will engage providers and other business and community partnerships to ensure members have comprehensive access to services.
ESSENTIAL RESPONSIBILITIES: Provider Contract Administration, Monitoring and Oversight

1. Develop contract proposals to support organizational goals and strategies
2. Evaluate, screen, and review contract proposals and estimates to determine whether they seem reasonable and accurate
3. Prepare analyses, reports, and presentations by collecting, analyzing, and summarizing information and trends
4. Conduct financial analyses to identify develop, and implement competitive reimbursement
5. Negotiate key financial, operational, and legal terms with hospitals, physicians, and ancillary providers, while ensuring that contracts remain within the established budget
6. Ensure all negotiated terms are accurately and thoroughly documented in contractual agreements in order to mitigate financial or legal risk to the organization
7. Manage the organization's Value-Based Payment Program: plan, develop, and modify new and existing value-based contracts to ensure the organization effectively supports cost reduction, quality improvement and adherence to value-based contracting requirements
8. Maintain organized system of physical and digital records, including archived records
9. Engage legal counsel and compliance department when needed to ensure appropriate negotiation, documentation, performance, and termination of contracts
10. Review and update existing contracts
11. Explain terms and conditions to managers and interested parties
12. Ensure that employees understand and comply with company contracts, notifying appropriate staff of contract commencement and associated activities
13. Analyze and identify potential risks involved with specific contract terms
14. Stay up-to date with legislative changes and coordinate with the CFO, Compliance Officers, and other departments as needed
15. Submit all required documentation to the state within prescribed timeframe and within all contractual obligations
16. Ensure all deadlines and conditions described on contracts are met
17. Ensure that all records are accurate and up to date and create regular status reports regarding progress on projects
18. Write contract letters and other communications and notices
19. Attend meetings to assess progress on projects which are in motion, and take detailed notes to share with stakeholders
20. Lead efforts to identify, implement, and maintain a digital contract management system
21. Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
22. Handle confidential information and materials appropriately and maintains a secure work area
23. Other duties as assigned

ESSENTIAL RESPONSIBILITIES: Compliance

• Participate in compliance activities when requested, including assistance with audit preparation, when the focus is compliance with contract requirements
• Engage Compliance department as needed to ensure that all contracts meet the CCO contract and subcontract requirements as well as ensure that deliverables involving contracts are timely submitted to the Oregon Health Authority (OHA)

ESSENTIAL RESPONSIBILITIES: Quality Improvement

• Participate in quality and organizational process improvement activities and teams as directed
• Lead person for audit preparation when focus is contract administration
• Support and contribute to effective safety, quality, and risk management efforts by adhering to established; policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities

ESSENTIAL RESPONSIBILITIES: Communication & Teamwork

• Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner
• Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization
• Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer's expectations
• Strive for accuracy in all functions of the department processes

ESSENTIAL RESPONSIBILITIES: Professional Development

• Recognize new developments and remain current in contract administration and business best practice standards and anticipate organizational modifications
• Advance personal knowledge base by pursuing continuing education to enhance professional competence
• Promote individual and organizational integrity by conducting ethical behavior to maintain high standards
• Represent organization at meetings and conferences as applicable

EDUCATION AND EXPERIENCE REQUIREMENTS
Bachelor's in Business Administration, Accounting, Finance, or related field required; additional qualifications in law are a plus. Two to three years in a contract administration role or related field required. Three to five years in a similar setting such as managed care, CCO, or other health plan experience required. A strong understanding of Provider reimbursement and value-based payments preferred.
KNOWLEDGE

• Knowledge of contract law
• Strong knowledge of business financial best practices
• Familiarity with accounting procedures
• Knowledge and understanding of how the positions' responsibilities contribute to the department and company goals and mission
• Knowledge of federal and state laws including OSHA, HIPAA, Waste Fraud and Abuse
• awareness and understanding of equity, equity lens, diversity, and inclusion
• Training in or awareness of Health Literacy, Poverty Informed, Systemic Oppression, language access and the use of healthcare interpreters, uses of data to drive health equity, Cultural Awareness, Trauma-Informed Care, Adverse Childhood Experiences (ACEs), Culturally and Linguistically Appropriate Service (CLAS) Standards, and universal access

SKILLS AND ABILITIES

• Proficient in Microsoft Office Suite
• Strong attention to detail and highly organized
• Excellent writing and communication skills
• Strong analytical skills
• Excellent negotiation skills
• Non-judgmental attitude
• Project management skills
• Ability to report to work as scheduled
• Ability to handle stress and sensitive situations effectively while projecting a professional attitude
• Willingness to work a flexible schedule when circumstances necessitate
• Ability to communicate professionally, both orally and in writing
• Ability to work with diverse populations
• Ability to relate to and interact with people of differing personalities and backgrounds
• Sensitive to economic considerations, human needs and aware of how one's actions may affect others
• Ability to organize and work in a sensitive manner with people from other cultures
• Poised; maintains composure and sense of purpose

WORKING CONDITIONS
This position must have the ability to remain in a stationary position, occasionally move about inside the office to access office machinery, printer, etc., frequently communicate and exchange accurate information.

• Work Condition:
  • Employee generally works within the interior of an office environment.
  • Employee may travel locally and be responsible for own transportation. Out of area travel may be required on occasion.
  • Hours of operations and specific staff scheduling may vary between worksite based on operational need.
  • The general environment is clean with a comfortable temperature and moderate noise level.
• Exposed to: Cold/heat controls, close contact with employees and the general public.
• Machines, equipment..... click apply for full job details
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