Provider Network Contract Administrator

JOB DESCRIPTION

PROVIDER NETWORK CONTRACT ADMINISTRATOR

The Center for Elders Independence is a PACE (Program of All-Inclusive Care for the elderly) organization (PO) that uses an interdisciplinary team approach for care planning and implementing purposeful high quality, affordable, and integrated health care services to the elderly. Our elderly meet PACE requirements as prescribed by CMS and are referred to as participants. Our PO includes Adult Day Health Centers and primary care clinics, promoting participant autonomy, quality of life and the ability for individuals to live in their communities

THE POSITION:

The Provider Network Contract Administrator evaluates and negotiates contracts in compliance with company contract templates, standards, and other key process controls. Responsibilities include establishing and maintaining strong business relationships with Hospital, Physician, or Ancillary providers. This position will report to the Chief Financial Officer .

DUTIES AND RESPONSIBILITIES:

Research for new Providers, new Vendor leads, research for comparison contract pricing of physicians, consultants, and other vendors.

Draft, manage, and negotiat e a wide range of contracts including providers, commercial, and suppliers.

Through communications, ensure all Providers are in compliance with current business and professional licenses, certifications and is not on exclusion lists.

Manage renewal or termination of service agreements, and Provider contracts.

Monitors contract and enforce terms.

Nurture P rovider partnerships to seek broader opportunities including Risk, Value Based, Fee for Service, and provider specific contracts.

Ensures effective implementation of new and re - newing contracts through communication and coordination with other functional areas.

Monitors P rovider contracts to ensure terms and conditions are met.

Creates, negotiates and incorporates contract amendments, renegotiating the contract to accommodate scope changes or changes in organization requirements.

Provides feedback to the appropriate management personnel when issues are identified relative to patient care, billing, and authorization.

Works closely with Quality, Claims and centers to identify and resolve operational issues relating to contract development, administration, and to facilitate quality of service and reimbursement.

Responsible for the regular monitoring, collection, and reporting of performance metrics, territory profile reporting of field operations activities, and the coordination of activities.

QUALIFICATIONS:

Bachelors degree in Health Care Administration or related field or equivalent work experience required.

Certified Professional Contracts Manager (CPCM) a plus.

3-5 years prior experience in healthcare/managed care contracting, and/or healthcare finance required.

Minimum 3 years network management-related role experience handling complex network

Knowledge of Medicare and Medicaid regulatory requirements and practice protocols.

Knowledge of reimbursement methodologies and CPT, ICD10, and capitation.

Knowledge of quality assurance and utilization management concepts.

Knowledge of claims processing systems and guidelines

Demonstrate excellent oral and written communication skills that are clear, concise and actionable and ability to communicate at all levels within the organization.

Creative problem solver with a demonstrated ability to communicate specific barriers to the contracting process with recommended solutions.

Organized abilities and detail oriented.

Able to work independently and as a team.

The above job description is intended to communicate the general function of the mentioned position and by no means shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required. CEI reserves the right to change job descriptions, site assignments, and or work hours as required by the needs of the program. All employees are expected to perform their duties within their ability as required by the job and/or as requested by management.

Center for Elders Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a capitation healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.