Managed Care Contracts Specialist (Full-Time, 40 Hours, Day Shift)
The Queen's Health Systems, Honolulu, HI, United States
Responsibilities
Assists in development, maintenance and administration of the medical centers’ contracts with health insurers for services provided to members.
Performs financial analysis, operational evaluation, and compliance issues on payer agreements to recommend action for executive review.
Makes recommendations for optimal member utilization and objective financial criteria.
Functions as a member of the contracting team to negotiate optimal contractual agreements.
Responsible for maintenance of contract modules.
Serves as a liaison with selected payers to promote the service of the medical center and improve provider relations with third party payers.
Typical Physical Demands
Essential/continuous: Sitting, finger dexterity seeing, hearing, speaking, repetitive arm/hand motions, static gripping of an object for prolonged periods, frequent gripping of an object.
Operates computer, typewriter, calculator, telephone, fax and printer.
Typical Working Conditions
Not substantially subjected to adverse environmental conditions.
Minimum Qualifications
Education / Certification and Licensure
Bachelor’s degree in Business, Finance or Health Care Administration or four (4) years with health care provider or payer in contracting or business operations.
Master’s degree in related field preferred.
Knowledge of healthcare delivery systems, including contracting and financial analysis.
Knowledge of current regulatory billing and collection policies and procedures.
Knowledge of computer assisted analytical tools including word processing, spreadsheet, and software for hospital contract and/or claims management.
Experience
In addition to the educational requirement, two (2) years experience with a health care provider or payer in contracting or business operations.
Demonstrated ability to work independently and effectively with internal and external personnel at various levels of responsibility.
Equal Opportunity Employer/Disability/Vet
#J-18808-Ljbffr
Assists in development, maintenance and administration of the medical centers’ contracts with health insurers for services provided to members.
Performs financial analysis, operational evaluation, and compliance issues on payer agreements to recommend action for executive review.
Makes recommendations for optimal member utilization and objective financial criteria.
Functions as a member of the contracting team to negotiate optimal contractual agreements.
Responsible for maintenance of contract modules.
Serves as a liaison with selected payers to promote the service of the medical center and improve provider relations with third party payers.
Typical Physical Demands
Essential/continuous: Sitting, finger dexterity seeing, hearing, speaking, repetitive arm/hand motions, static gripping of an object for prolonged periods, frequent gripping of an object.
Operates computer, typewriter, calculator, telephone, fax and printer.
Typical Working Conditions
Not substantially subjected to adverse environmental conditions.
Minimum Qualifications
Education / Certification and Licensure
Bachelor’s degree in Business, Finance or Health Care Administration or four (4) years with health care provider or payer in contracting or business operations.
Master’s degree in related field preferred.
Knowledge of healthcare delivery systems, including contracting and financial analysis.
Knowledge of current regulatory billing and collection policies and procedures.
Knowledge of computer assisted analytical tools including word processing, spreadsheet, and software for hospital contract and/or claims management.
Experience
In addition to the educational requirement, two (2) years experience with a health care provider or payer in contracting or business operations.
Demonstrated ability to work independently and effectively with internal and external personnel at various levels of responsibility.
Equal Opportunity Employer/Disability/Vet
#J-18808-Ljbffr