Prospect Medical Systems ยท 4 days ago
Contract Specialist
Orange, CA
Contract
Remote
Mid Level
3+ years exp
Maximize your interview chancesHospitals and Health Care
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Responsibilities
Negotiate and draft agreements and amendments outlining contractual terms as directed.
Engage in specialty provider recruitment efforts to support network adequacy requirements.
Present contracts and amendments for execution.
Draft provider terminations and other provider correspondences.
Initiate Alerts for adds, terms, and changes to internal departments for claims and referral system updates, health plan submissions, and member outreach as needed.
Load agreements and providers to contracting data application with all contractual terms and linkages.
Manage Claims Inquiries email box and Referral Queue.
Negotiate MOUs as needed for referrals to non-contracted providers and secure savings for non-contracted claims.
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.
Follow up for return of signed contracts, amendments, credentialing applications, and attestations.
Works with credentialing department as needed to obtain credentialing and re-credentialing documents.
Provides administrative support to Contract Administrator and Contract Manager.
Generate reports as requested and other duties as assigned.
Track and document tasks to completion.
Qualification
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Required
Three (3) years contract negotiations in a managed care environment working with Medicare and Medicaid fee schedules required.
Knowledgeable of Commercial, Medicare, Medicaid lines of business required.
Maintain confidentiality and adhere to all regulatory requirements as well as to policies and procedures.
Associates degree or equivalent education and experience.
Company
Prospect Medical Systems
With approximately 9,000 physicians to serve our 660,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Arizona, Texas, and Rhode Island.
501-1,000 employees
Funding
Current Stage
Late StageLeadership Team
Jim Brown, MBA, MPH
Chief Executive Officer
L
Lily Kam
Chief Financial Officer
Company data provided by crunchbase
