job summary: Our client is currently seeking a Contracts Analyst II for a 3 month contract to hire opportunity located in San Rafael, CA.
Minimum 3 years contracting experience in healthcare
Proficient in Word and Excel
location: San Rafael, California
job type: Contract
salary: $30 - 40 per hour
work hours: 8am to 5pm
responsibilities: Job Description:
Serve as the subject matter expert to on issues related to provider reimbursement Job Responsibilities:
- Evaluate the effectiveness of contracting strategies, payment methodologies and rates in comparison to budget of quality initiatives
- Establish financial benchmarks for provider reimbursement and analyze the impact of contracts submitted by the Health Plans Manage and modify the process for changes to outcomes analysis reports due to various needs and concerns
- Prepare and present information on emerging and industry standard reimbursement methods, competitive information, and national initiatives to management in support of network strategy discussions
- Oversee various projects including the design of physician incentives and other contractual arrangements
- Maintains divisional provider reimbursement models providing analytic reporting capabilities for contracting staff, contract settlement, incentive pool distribution, and estimation of savings through a variety of proposed contract/reimbursement actions
- Perform analyses of Health Plan reimbursements in comparison to national experiences
- Develop, export and train Health Plan financial analysts on the use financial modeling tools for provider reimbursement and medical expense forecasting
- Assist with formulating and administering organization policies and procedures
- Bachelor's degree in related field or equivalent experience.
- Working knowledge of contract management processes, claims processing procedures, reimbursement and payment methodologies, and claims systems requirements and controls.
- Experience with statistics and the application of higher level mathematical models to medical and pharmacy claims data.
- 2-4 years of experience
skills: Day to Day Responsibilities:
- "Contract Administrator". This is within the Provider Network Contracting team.
- Will negotiating contracts with providers.
- Looking and analyzing rate increase requests.
- Single case agreements (AKA letter agreements)
- Administers or negotiates contracts/subcontracts and associated change orders/modifications.
- Researches contract interpretations and drafts conclusions.
- Researches contract/subcontract requirements and drafts position papers or correspondence.
- Oversees accuracy and integrity of databases. Gathers data, builds/runs reports.
- Maintains contract files. Maintains centralized filing system for the department and works with key customers in the retrieval and organization of data. Assembles provider contract documents and handles distribution to customers that include copies of contracts and routine contract distributions.
- Identifies problems and data trends and recommends appropriate follow up. Assists in the development of desktop procedures related to data management and initiatives.
- Assists in the education of data entry processes for new trainees on departmental systems and processes.
- Coordinates and assists on projects.
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
Qualified applicants in San Francisco with criminal histories will be considered for employment in accordance with the San Francisco Fair Chance Ordinance.
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.