Physician Contract Specialist - Managed Care Contracting

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Date: May 3, 2019

Location: Newport Beach, CA, US

Company: Hoag Memorial Hospital Presbyterian

Job Description:

The Physician Contract Specialist is responsible for negotiating and executing Physician, hospital and/or other provider contracts and agreements for the organizations capitated HMO population.   

 

The Physician Contract Specialist is also responsible for negotiating and executing Letters of Agreements, specialty agreements and ancillary contracting (purchased services) as may be applicable for a patient that Hoag Hospital or one of their affiliates may have a risk for. 

 

Essential Job Functions:

 

  • Identify and recommend potential provider contracting strategies to reduce costs, limit financial risk and ensure adequate provider network to service members.
  • Negotiate provider agreements (physician, hospital, ancillary) within the financial and strategic guidelines established.
  • Review and analyze proposed contract terms and conditions of physician contracts and amendments to determine which terms are acceptable and which terms require further negotiation.
  • Monitor contract performance against negotiated terms and conditions.
  • Maintain a consistent timeline for evaluating contracts and renegotiations.
  • Monitor medical group utilization of non-contracted providers and develop action plans as needed to re-educate or obtain contracts
  • Monitors and updates contracts required to comply with state and federal law, regulatory or plan requirements.
  • Maintain physician contract database (SharePoint) to ensure contracts are archived and available to Hoag Executive Leadership as applicable.
  •  May assist with identifying and recruiting providers based on network composition and needs.
  • Innovates improves and problem solves to further the goals and achieve the operating and strategic plans of the organization.  Identifies opportunities for physician contract improvement.
  • Performs other duties as assigned.

 

Education, Training & Experience:

 

Required:

  • Minimum of 5 years experience in managed care operations within a hospital, IPA or health plan environment with atleast 3 years of experience in contract negotiations. 
  • Bachelor's degree in Business Administration or related field or an equivalent combination of education and experience. 

 

Skills or Other Qualifications:

 

Required:

  • Knowledge of Federal and State laws including Stark and Anti-Kickback as they apply to physician contracts.

  • Knowledge of complex reimbursement methodologies

  • Excellent communication/interpersonal and organizational skills.

  • Ability to problem-solve, analyze situations, and think critically.

  • Computer experience and proficiency with MS Word software.

  • Ability to work independently, manage multiple time deadlines and work with an atmosphere with frequent changes.

  • Comfortable with interaction with all levels of management while maintaining an attitude or professionalism and collaboration.

  • Ability to work in a fast-paced environment.


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

Job Segment: Contract Manager, Medical, Law, Developer, Physician, Legal, Healthcare, Technology

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