CONTRACT SPECIALIST - MANAGED CARE CONTRACTING

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Date: May 11, 2019

Location: Newport Beach, CA, US

Company: Hoag Memorial Hospital Presbyterian

Job Description:

Manages the Hoag Network contracting process for the Managed Care Contracting Department, Distributes all new and amended PPO/HMO/Ancillary agreements to internal/external stakeholders as applicable.

 

Responsible for the ongoing maintenance and testing of Hoag Network contracts in EPIC.

 

Responsible for ongoing audits of contract reimbursement terms working with payors to address all reimbursement issues.

 

Maintains contract files and online access to contracts and various databases, coordinates flow of contract documents for signature throughout the organization, communicates Contract Information to internal and external customers, provides administrative assistance if needed.

 

Job Specific Essential Functions:

 

  • Responsible for submitting new and amended contracts, fee schedules, division of financial responsibility (DOFR) to Epic for implementation.
  • Working directly with Epic Analyst to ensure timely update of systems.
  •  Responsible for providing regulatory coding and reimbursement updates for Medicare and Medi-Cal where appropriate.
  • Responsible for ongoing testing of contract terms in Epic by reviewing both paid and unpaid accounts in Epic.
  • Works directly with internal/external departments on requests for payer plan codes and ensures all processes and systems are updated accordingly with any changes.
  • Attends all Epic governance meetings related to plan codes and contract related matters.
  • Researches and resolved all contract related revenue cycle issues, working directly with health plans until resolved.
  • Researches and respond appropriately to all Hoag Network office inquiries.
  • Communicates Managed Care Contract rate information to appropriate departments and Epic.
  • Maintains confidential files and online access for PPO, HMO, Ancillary and other contracts.
  • Responsible to provide assistance for all Hoag Network credentialing/re-credentialing which includes but is not limited to HOI, ASC’s, Ancillary and Physicians, providers by proactively requesting required documentation at the time of contract signature and as documents needed.
  • Tracks the contract and other forms requiring signature process with administration and the department until fully-executed and following up as needed.
  • Distributes current referral listing of contracted ancillary providers monthly to internal/external stakeholders where applicable
  • Able to step in and work multiple functions in the Managed Care department.
  • Assists management with special projects.

 

Education, Training & Experience:

 

Required:

  • High School diploma and three years experience in an office setting, preferably in health care or managed care.
  • Understanding health insurance plans (HMO, PPO, etc.).
  • Computer knowledge required including Word and Excel.

 

Preferred:

  • Two years of college. 

 

Skills or Other Qualifications:

 

Required:

  • Demonstrates effective communication, interpersonal skills, organizational ability, and ability to follow instructions.
  • Ability to operate a personal computer and be familiar with standard office equipment.
  • Must be able to set assignment priorities, work independently within established guidelines and maintain confidentiality.
  • Familiarity with all office equipment and basic math concepts.
  • Ability to organize and maintain files.
  • Ability to interact with many different internal and external customers.

 

Position Reports to Sr. Contracts Manager

 


Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Contract Manager, Law, EMR, Medicare, Legal, Healthcare

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