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Contract Specialist

Beacon Health Options • US-Nationwide

Posted 1 month ago

Job Snapshot

Full-Time
Experience - 2 to 3 years
Degree - High School
Other Great Industries
Legal

Job Description

ABOUT THE POSITION

The Contract Specialist identifies and recruits Physicians, providers and Medical Groups to fulfill Beacon network needs.

Position Responsibilities:

  • Primarily negotiates professional rates and contract terms with both new and contracted providers.
  • In conjunction with internal and external stakeholders, secure executed agreements with identified out of network providers for inclusion in the Beacon Health network.
  • Works closely with network Contract Manager and other contract leadership and other staff (e.g., credentialing) to assure client performance guarantees related to network access are met.
  • Leverages a variety of tools (e.g., geo-access, customer requests, published provider directories) to identify and pursue provider recruitment to close network gaps.
  • Identifies opportunities for cost savings and process improvements related to the contracting process.
  • For assigned contracts reviews, draft and document suggested language changes, and oversee resolution of all proposed changes to the provider services agreement.
  • Ensures that Contract Language is in compliance with plan agreements and within all state and federal regulatory and NCQA standards.
  • Gather, review and submit credentialing applications, as required, for network development and management.
  • Provides general support to all network development activities and support Director and other Contract team with implementation requirements.
  • Strategizes with other members of the management team to ensure access and availability of providers meets current standards.
  • Collaborates with other departments to address and resolve operational issues as related to negotiated contract language.
  • Prepares and submits under the direction of Network leadership required internal requests for system configuration, provider demographic data changes or claims processing in support of assigned market
  • Adheres to all Beacon policies and procedures and standards of operations.
  • Completes all required and assigned trainings.
  • Attends all mandatory company or department meetings.
  • Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.
  • Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  • Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.
  • Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.
  • Assist team members and offers suggestions to improve processes, culture, or work environment.
  • Performs special projects and other duties as assigned and required.

Position Requirements:

Education: High School Diploma required. Bachelor’s Degree in Business, Finance or Health Care Management preferred.

Relevant Work Experience:

  • Minimum of 2-3 years’ experience in managed care ideally in provider relations, behavioral health organization or similar. Strong understanding of Physician reimbursement methodologies - behavioral health experience a plus.
  • Knowledge of managed care contract requirements to include state and federal regulatory requirements for Medicare and Medicaid plans and CMS guidelines.
  • Intermediate skill knowledge of electronic health record and electronic medical record software systems; FlexCare, Raintree, Connect preferable.

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

$REM

Job ID: 56301
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