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Charter Healthcare · 5 months ago

Payer Contract Specialist

Rancho Cucamonga, CA

Contract

Onsite

Mid, Senior Level

5+ years exp

Charter Healthcare is seeking a Payer Contract Specialist responsible for managing day-to-day operations related to managed care contracting and payer/provider relations. The role involves acting as a liaison between agencies and health plans, ensuring compliance, and maintaining provider relationships.

Health CareMedical

Responsibilities

Develop, negotiate, and maintain contracts with all payers, e.g., insurance companies, , MSOs, IPAs, TPAs, and government programs. This includes researching territories to identify gaps with our payer base and supporting the expansion into new markets

Assure contractual arrangements meet financial targets and legal/regulatory compliance requirements. There will be an emphasis on analyzing cost and utilization data

Facilitate the approval process of all contract documents from pre-contract through post-signature phases

Responsible for the accuracy of supporting documentation for contracts and completing documents accurately

Maintain existing relationships with contracted providers. Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, medical policy changes and reimbursement

Complete Medicare enrollment for new entities and markets. Coordinate with internal teams as necessary to support Medicare assignments

Track and report contract renewal dates and alert management 90 days prior to renewal dates

Track contract status and ensure contracts transition to the next stage in the life cycle timely

Monitor for rate renewal, increases, and changes to ensure we realize the intended negotiated contracted rate

Meets routinely with system and health plans to resolve contracting/claims issues

Supports contract negotiation efforts by revenue modeling and rate evaluation

Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy and binning policies

Assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes

Serve as a point of contact on health plan architecture, network restrictions, product offerings and other components of the health plan marketplace

Maintain excellent written and verbal communication with all internal and external customers

Assist with all contracting administration and projects, as needed

All other duties and responsibilities as assigned

Qualification

Payer contractingContract negotiationHealthcare industry knowledgeAnalytical skillsInterpersonal skillsOrganizational skillsComputer software proficiencyCommunication skillsLeadership experience