The Contract Administrator will work with the Contract Manager and the contracting team to develop and anage Provider Networks through contracted primary care physicians and specialists, key hospitals, ancillary and any other necessary providers to support the IPA’s goals including a healthy population, while managing costs and achieving high quality measures.
Bachelor’s Degree and/ or a minimum of three years of recent experience and successful track record in healthcare contracting.
Strong computer skills (word processing, spreadsheets, database access, Outlook, Ez-Cap).
Strong communication and negotiation skills including excellent verbal and written abilities.
Ability to prioritize and multi-task while paying attention to detail.
Adapt to changes easily.
Strong analytical and problem solving skills.
Customer focused and expeditious follow-up skills.
Deadline conscious.
Strong ability to collaborate with other staff/team members.
Big Thinker. Sees the big picture and looks for process improvement.
Ability to learn in-house and other systems quickly with minimal training.
Possess a high level of motivation and professionalism and demonstrate ethical conduct and good judgment at all times while conducting company business.
Develop and maintain provider contracted networks and execute contracts that support network needs.
Review implementation to ensure contract is appropriately administered.
Develop and maintain strong, cost effective and mutually supportive relationships with key providers and clients.
Ensure timely administration/implementation of contract terms.
Act as technical resource on contract related issues.
Maintain internal contract database for management of accurate data and complete contract detail.
Coordinate with contract negotiators, performs analysis of contracting needs, including assessment of claims and utilization data, to identify areas for new and re-negotiated contracts.
Advise other departments of new contracts and amendments, including updating of all internal systems and processes.
Research, analyze and resolve complex problems dealing with hospital shared risk pool, claims, appeals, authorizations and eligibility issues, as it pertains to the contract, within the appropriate time limits.
Use, protect, and disclose all patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Maintain and manage letters of intent from prospective providers.
Assist with health plan documents and DOFR’s, as needed.
Maintain contract templates and amendments and ensures templates are compliant with State and Federal law, internal operations, products and financial requirements.
Represent department in internal and external audits.
Continually seek out opportunities for functional improvement and improved business processes.
Participate in regularly scheduled Joint Operations Committee meetings (JOCs).
Participate in interdepartmental meetings and selected committees and substitute for Contract Manager on an as needed basis.
Perform other duties as assigned