Contracting Specialist
Department:
Provider Contracting
Employment Type:
Full Time
Location:
600 City Parkway West 10th Floor, Orange, CA 92868
Reporting To:
Sukanya Hegde
Compensation:
$25.71 - $32.99 / hour
Description Job Title: Contracting Specialist Department: Provider Contracting About the Role:
Astrana Health is looking for a Contracting Specialist. This role will report to our Director - Provider Contracting Operations and enable us to continue to scale in the healthcare industry.
What You'll Do
Supports contracting efforts and loading for provider contracts
Negotiate Patient Specific MOUs
Process, Load, and maintain contracts and providers in contracting database application
Acts as liaison with various internal departments to facilitate and resolve claims, provider configuration, customer service, credentialing, and other related issues.
Negotiate and draft LOA/MOU agreements outlining contractual terms as directed
Draft provider terminations and other provider correspondences
Initiate changes to internal departments for updates, health plan submissions, and member outreach as needed
Load agreements and providers to contracting data application with all contractual terms and linkages
Manage Inquiries email box and Referral Queue
Provide clarification on contractual arrangements to internal departments, providers and billing companies
Provides customer service to network providers and other internal departments by responding to contracting inquiries, claims questions, and credentialing inquiries, and provider configuration
Problem solve inquiries regarding contract or provider setup
Works with credentialing department as needed to obtain credentialing and re-credentialing documents
Track and document tasks to completion
Generate reports as requested
Other duties as assigned
Qualifications
Proven ability to prioritize and organize while ensuring attention to detail
Work independently to ensure established turn around times and project deadlines are met
Proficient in Microsoft Office Suite
Working knowledge of DOFRs, Claims, Utilization Management, Network Management, Eligibility, CPT Coding, Diagnosis Coding and Medical Terminology
Strong communication, critical thinking, problem resolution, and interpersonal skills
Ability to read, comprehend, and interpret managed care contractual agreements
Required Education/Experience:
Three years contract negotiations in a managed care environment working with Medicare and Medicaid fee schedules
Maintain confidentiality and adhere to all regulatory requirements as well as to policies and procedures
Associates degree or equivalent education and experience
You're great for the role if:
You have knowledge of Commercial, Medicare, Medicaid lines of business
Environmental Job Requirements and Working Conditions
This is a remote position. The home office is located at 600 City Parkway West 10th Floor, Orange, CA 92868.
This position requires coming into office at least once per month at our offices located in 1600 Corporate Center Dr., Monterey Park, CA 91754 and 600 City Parkway West 10th Floor, Orange, CA 92868. Additional in-office days may be required based on business needs or special projects.
The total compensation target pay range for this role is $25.71 - $32.99 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affiantitative Action employer. We do not discriminate based upon race, religion, color, national (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
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Provider Contracting
Employment Type:
Full Time
Location:
600 City Parkway West 10th Floor, Orange, CA 92868
Reporting To:
Sukanya Hegde
Compensation:
$25.71 - $32.99 / hour
Description Job Title: Contracting Specialist Department: Provider Contracting About the Role:
Astrana Health is looking for a Contracting Specialist. This role will report to our Director - Provider Contracting Operations and enable us to continue to scale in the healthcare industry.
What You'll Do
Supports contracting efforts and loading for provider contracts
Negotiate Patient Specific MOUs
Process, Load, and maintain contracts and providers in contracting database application
Acts as liaison with various internal departments to facilitate and resolve claims, provider configuration, customer service, credentialing, and other related issues.
Negotiate and draft LOA/MOU agreements outlining contractual terms as directed
Draft provider terminations and other provider correspondences
Initiate changes to internal departments for updates, health plan submissions, and member outreach as needed
Load agreements and providers to contracting data application with all contractual terms and linkages
Manage Inquiries email box and Referral Queue
Provide clarification on contractual arrangements to internal departments, providers and billing companies
Provides customer service to network providers and other internal departments by responding to contracting inquiries, claims questions, and credentialing inquiries, and provider configuration
Problem solve inquiries regarding contract or provider setup
Works with credentialing department as needed to obtain credentialing and re-credentialing documents
Track and document tasks to completion
Generate reports as requested
Other duties as assigned
Qualifications
Proven ability to prioritize and organize while ensuring attention to detail
Work independently to ensure established turn around times and project deadlines are met
Proficient in Microsoft Office Suite
Working knowledge of DOFRs, Claims, Utilization Management, Network Management, Eligibility, CPT Coding, Diagnosis Coding and Medical Terminology
Strong communication, critical thinking, problem resolution, and interpersonal skills
Ability to read, comprehend, and interpret managed care contractual agreements
Required Education/Experience:
Three years contract negotiations in a managed care environment working with Medicare and Medicaid fee schedules
Maintain confidentiality and adhere to all regulatory requirements as well as to policies and procedures
Associates degree or equivalent education and experience
You're great for the role if:
You have knowledge of Commercial, Medicare, Medicaid lines of business
Environmental Job Requirements and Working Conditions
This is a remote position. The home office is located at 600 City Parkway West 10th Floor, Orange, CA 92868.
This position requires coming into office at least once per month at our offices located in 1600 Corporate Center Dr., Monterey Park, CA 91754 and 600 City Parkway West 10th Floor, Orange, CA 92868. Additional in-office days may be required based on business needs or special projects.
The total compensation target pay range for this role is $25.71 - $32.99 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affiantitative Action employer. We do not discriminate based upon race, religion, color, national (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
#J-18808-Ljbffr