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Contracts Specialist, Sr.
CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.
The Contracts Specialist Sr. contracts with and manages a variety of health care provider contracts and relationships needed to serve CalOptima members. Th e incumbent will interface directly with a variety of provider types, including individual physicians, physician groups, hospital, and ancillary providers for contracting purposes. The Contracts Specialist Sr. will implement work with many levels of CalOptima leadership and staff supporting provider contracts and related needs.
- Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Presents CalOptima and the health plan's provider contracts to interested providers and initiate or facilitate provider credentialing as needed.
- Initiates and manages contracts through to execution.
- Must be able to describe the different CalOptima programs, Managed Care Plan (MCP) County Organized Health System (COHS) Medi-Cal model, government program payment guidelines, and manage on-going MediCal, Dual-Special Needs Plan (D-SNP), Cal MediConnect, and PACE related provider contracts as assigned.
- Effectively communicates with both internal and external customers to help facilitate contracting efforts, and on-going relationship building with Orange County's provider community as needed.
- Collaborates closely with the Managers and Director of Contracting on multiple contracting projects and keeping leadership abreast on progress, issues, and status of new contracts in the Contract Management data base.
- Responds to provider and internal departments regarding questions, and inquiries that relate to contract terms and related policies.
- Works closely with internal departments regarding provider contract obligations and rates.
- Creates, tracks and monitors status of new contracts in the Contract Management data base.
- Prepares summaries and detailed reports regarding contracted provider network and assigned projects as needed.
- Coordinates and executes Letters of Agreement (LOA) with non-contracted providers under direction from Contracting management.
- Requests and interprets applicable financial data with guidance from CalOptima's Finance and Claims departments to analyze the impact of rate increases or the implementation of other payment methodologies.
- Completes other projects and duties as assigned.
Possesses the Ability To:
- Follow CalOptima policies and procedures.
- Comprehend CalOptima's different government health care programs, how they differ, who they serve, and specific rules and financial terms.
- Understand financial analysis that is related to contract payment terms, program rules, and related impacts to budget and planning.
- Communicate clearly and concisely, both orally and in writing. Must be able to clearly describe the issues and develop recommendations for consideration.
- Establish and maintain effective working relationships with CalOptima leadership and staff.
- Explain CalOptima's programs and different government health care program payment methodologies.
- Understand contract language, rate schedules, and program policy and procedures.
- Respond appropriately to contracted provider inquires and coordinate resolution with appropriate departments including facilitating warm hand offs.
- Plan and facilitate meetings as needed and prioritize tasks to meet challenging deadlines.
- Work in a fast-paced environment with many changes and many inputs.
- Act as a contracting liaison between the provider and CalOptima.
- Have strong organizational, prioritization and time management skills.
- Utilize computer and appropriate software (e.g. Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems (e.g. Contract Management) to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience & Education:
- Bachelor's degree required.
- 3 years of experience in the health care field interacting directly with providers required.
- An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
- Have access means of transportation for work away from the primary office approximately 5% of the time.
- Managed Care contracting experience preferred.
- Managed care contracts and various reimbursement methodologies, health plan delivery models (capitation vs. fee-for-service Medicare, Medi-Cal, commercial plans, etc).
- Guidelines and regulations specific to the health care field.
Reports to: Manager, Contracting
FLSA status: Non-Exempt
Salary Grade: K - $33.65 - $51.83 ($70,000 - $107,800)
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.
Job Location: Orange, California
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/3902
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