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Sharp HealthCare · 9 hours ago

Contracts Associate - SCMG Capitation Administration - Sharp Corporate - Day Shift - Full Time

San Diego, CA

Full-time

Onsite

Mid Level

$39.69/hr - $57.37/hr

4+ years exp

Sharp HealthCare is a leading healthcare provider, and they are seeking a Contracts Associate to assist with the operations, negotiations, and analyses of contracts and capitations with providers. The role involves overseeing contract administration, conducting negotiations, and providing operational support to ensure compliance and effective communication across departments.

Health CareNon Profit

Responsibilities

Responsible for requesting, preparing and analyzing data necessary for contract negotiations

Develop reports necessary to determine contract performance compared to budget and established standards

Conducts and participates in the successful completion of assigned contract negotiations as they relate to SCMG contracts

Assist in the development and maintenance of communication links throughout the system to identify reimbursement issues and participation in the development of action items for resolution

In addition, communicate current contract information

Assures contract information is communicated and coordinated to appropriate internal departments and audit is performed to ensure accurate contract claim/encounter pricing and other reimbursement terms

Work in conjunction with system representatives in the implementation of the IDX Contract Adjudication system

Assists with other duties as assigned, to be completed in an agreed upon format in an agreed upon time frame

Demonstrates teamwork by participating in achieving department goals

Shows willingness to help out with any task to ensure the success of the department

Works in a spirit of cooperation with all Sharp employees

Provide operational support to internal and external customers

Assist in project coordination with SCMG departments: Claims, Utilization Management, Provider Services, and Pharmacy Benefits Department

Maintains service orientation to representatives of SCMG through consistent assessment of needs and timely response to requests

Develops and maintains relationships with Physician and Provider contract representatives in support of the SCMG Mission, Values, and Philosophy and ensure timely response to contractual issues and contract compliance problems

Collaborates with other entities/departments to resolve identified issues with demonstrated improvement in operational flow

Demonstrates resolution of operational issues with targeted outcomes as negotiated with the Director

Maintains work place in safe condition

Assure appropriate chair height, keyboard and screen placement, securing electrical wiring, observing departmental safety policies and procedures

Reports safety hazards within 1-3 days from time problem first identified

Qualification

Managed Care contractingContract negotiationData analysisReport preparationExcel spreadsheet analysisRelationship managementPC computer utilizationManaged Care capitationRBPVS/CPT/ICD-10 coding

Required

4 Years experience in Managed Care contracting

Experience in a health related or contract negotiation environment

Experience in maintaining positive working relationships with Physician and Provider representatives

Must have experience with analyzing, interpreting data, and preparing reports

Associate's degree in Accounting, Finance, Business Administration, Health Care Administration; experience may substitute for education

Knowledge of Managed Care and Managed Care Contracts, experience in PC computer utilization for word processing and Excel spreadsheet analysis, and managerial skills is required

Working knowledge of Managed Care capitation, RBPVS/CPT/ICD-10 coding