Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
The Contract Specialist, Senior is a key contributor to the Contracting team. This position negotiates, develops, and maintains Letters of Agreements (LOAs), and healthcare services contracts which are moderately advanced to complex in nature; may also be responsible for Single Case Agreements (SCA), as assigned. Primary areas of focus include hospital systems and contracts with custom terms. This position also provides analytical, programmatic and project leadership for the department and serves as a resource throughout company for contract language and terms. This position maintains positive, effective relationships with contracted provider network with attention to ongoing service needs, as well as maintains effective relationships with internal departments impacted by contract changes. The Contract Specialist, Senior identifies expense outliers, performs financial analysis, and recommends reimbursement strategies.
Estimated Hiring Range $90,225.00 - $110,275.00
Bonus Target Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
Essential Responsibilities Contract and LOA Negotiation and Development
Manage internal contracting process, LOA, and external network relationships for assigned providers and programs.
Negotiate contract language and terms.
Negotiate, coordinate, and produce Letters of Agreement and other provider contract documents.
Build, maintain and leverage effective working relationships with external and internal constituents.
Financial Analysis and Reporting
Perform and review financial analysis with Contract department leadership, Contracting leadership of assigned area and Finance staff.
Perform advanced data gathering, analysis, and reporting in alignment with Contracting policies and procedures.
Lead the development and analysis for key programs and provide recommendations based on analysis.
Assist with the compilation of mandated reporting regarding contract payments.
Contract Administration
Oversee the tracking and monitoring of contracts, LOAs, and related metrics; may also be responsible for SCAs.
Ensure payments are made based on contract terms and assist with the facilitation of those payments as needed.
Ensure all necessary contract information is directed to Provider Services staff for provider data file entry and maintenance.
Assist in the resolution of provider issues related to contractual relationships.
Coordinate accuracy and maintenance of provider payment networks with System Coordinators.
Project Leadership
Provide program and advanced project leadership for assigned area to the Contracting department.
Collaborate with internal departments and leadership to determine appropriate changes to existing programs; participate in the design of new programs and payment models.
Create programmatic materials that educate the provider network and internal teams regarding changes to existing and new payment models.
Department Policies and Operations
Play a critical role in developing and maintaining contract infrastructure and procedures based on management direction.
Recommend provider payment and network strategies to the contract management team.
Orient CareOregon staff to contracting process; act as an advanced resource to staff on contract-related matters.
Required Experience and/or Education
Minimum 5 years’ progressive experience in managed care contracting, provider relations, network/business development, or financial analysis/accounting with a minimum of 2 years in contract negotiation, development, and administration
Preferred
Bachelor’s degree in business, Health Care Administration, Analytics, or related degree
Knowledge, Skills And Abilities Required Knowledge
Extensive knowledge of managed care and the Oregon Health Plan
Strong knowledge of federal Medicare regulations and state Medicaid rules (OARs)
Knowledge of claims administration and ability to implement contract reimbursement terms
Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), shared savings agreements, and ability to perform rate calculations
Strong knowledge of data analytics tools and methodologies
Knowledge of physician group, hospital, and facility operations
Skills And Abilities
Excellent analytical skills
Excellent written and verbal communication skills
Strong word processing, spreadsheet, and database skills
Ability to negotiate facility contract language and terms
Ability to develop and maintain effective relationships with providers and provider groups
Ability to achieve desired outcomes through effective use of negotiation skills
Ability to negotiate and implement complex reimbursement arrangements
Ability to maintain professional relationships with internal staff and departments
Ability to independently work with providers, provider groups and other populations in addressing and resolving problems
Ability to work independently, organize, prioritize, and manage multiple projects
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
Work Location: Hybrid-Office 1 day/week
We offer a strong Total Rewards Program.
This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre‑tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non‑benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.
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The Contract Specialist, Senior is a key contributor to the Contracting team. This position negotiates, develops, and maintains Letters of Agreements (LOAs), and healthcare services contracts which are moderately advanced to complex in nature; may also be responsible for Single Case Agreements (SCA), as assigned. Primary areas of focus include hospital systems and contracts with custom terms. This position also provides analytical, programmatic and project leadership for the department and serves as a resource throughout company for contract language and terms. This position maintains positive, effective relationships with contracted provider network with attention to ongoing service needs, as well as maintains effective relationships with internal departments impacted by contract changes. The Contract Specialist, Senior identifies expense outliers, performs financial analysis, and recommends reimbursement strategies.
Estimated Hiring Range $90,225.00 - $110,275.00
Bonus Target Bonus - SIP Target, 5% Annual
Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.
Essential Responsibilities Contract and LOA Negotiation and Development
Manage internal contracting process, LOA, and external network relationships for assigned providers and programs.
Negotiate contract language and terms.
Negotiate, coordinate, and produce Letters of Agreement and other provider contract documents.
Build, maintain and leverage effective working relationships with external and internal constituents.
Financial Analysis and Reporting
Perform and review financial analysis with Contract department leadership, Contracting leadership of assigned area and Finance staff.
Perform advanced data gathering, analysis, and reporting in alignment with Contracting policies and procedures.
Lead the development and analysis for key programs and provide recommendations based on analysis.
Assist with the compilation of mandated reporting regarding contract payments.
Contract Administration
Oversee the tracking and monitoring of contracts, LOAs, and related metrics; may also be responsible for SCAs.
Ensure payments are made based on contract terms and assist with the facilitation of those payments as needed.
Ensure all necessary contract information is directed to Provider Services staff for provider data file entry and maintenance.
Assist in the resolution of provider issues related to contractual relationships.
Coordinate accuracy and maintenance of provider payment networks with System Coordinators.
Project Leadership
Provide program and advanced project leadership for assigned area to the Contracting department.
Collaborate with internal departments and leadership to determine appropriate changes to existing programs; participate in the design of new programs and payment models.
Create programmatic materials that educate the provider network and internal teams regarding changes to existing and new payment models.
Department Policies and Operations
Play a critical role in developing and maintaining contract infrastructure and procedures based on management direction.
Recommend provider payment and network strategies to the contract management team.
Orient CareOregon staff to contracting process; act as an advanced resource to staff on contract-related matters.
Required Experience and/or Education
Minimum 5 years’ progressive experience in managed care contracting, provider relations, network/business development, or financial analysis/accounting with a minimum of 2 years in contract negotiation, development, and administration
Preferred
Bachelor’s degree in business, Health Care Administration, Analytics, or related degree
Knowledge, Skills And Abilities Required Knowledge
Extensive knowledge of managed care and the Oregon Health Plan
Strong knowledge of federal Medicare regulations and state Medicaid rules (OARs)
Knowledge of claims administration and ability to implement contract reimbursement terms
Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), shared savings agreements, and ability to perform rate calculations
Strong knowledge of data analytics tools and methodologies
Knowledge of physician group, hospital, and facility operations
Skills And Abilities
Excellent analytical skills
Excellent written and verbal communication skills
Strong word processing, spreadsheet, and database skills
Ability to negotiate facility contract language and terms
Ability to develop and maintain effective relationships with providers and provider groups
Ability to achieve desired outcomes through effective use of negotiation skills
Ability to negotiate and implement complex reimbursement arrangements
Ability to maintain professional relationships with internal staff and departments
Ability to independently work with providers, provider groups and other populations in addressing and resolving problems
Ability to work independently, organize, prioritize, and manage multiple projects
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.
Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
Work Location: Hybrid-Office 1 day/week
We offer a strong Total Rewards Program.
This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre‑tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non‑benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.
We are an equal opportunity employer
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.
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