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 set up 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 Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (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.
Additional Information:
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.
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 set up 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 Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (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.
Additional Information:
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.