Contract Specialist

Job Description

• The Contract Specialist is responsible for building, and maintaining positive working relationships between their team, Plan, and other stakeholders.
• The Contract Specialist ensures contract data and documents are represented correctly in all plan operating systems, functions as a pro-active contract administrator, and coordinates the resolution of contract administration issues relating to the loading of contracts:
• Demonstrates a working knowledge and ability to explain AmeriHealth, Plan regulations, policies, and procedures relating to provider contracts.
• This requires the Contract Specialist to stay current with all updates and revisions.
• Responsible for auditing contract documents and provider records for completeness and accuracy.
• Responsible for managing and monitoring Excel reports for projects and other assignments.
• Responsible for swiftly aligning contract documents to provider records in the operating system with 95% accuracy.
• Responsible for swiftly creating contract records in the contract management system with 95% accuracy.

Responsible for provider contract management

• Demonstrates a functional knowledge of managed care provider types, contract types, and reimbursement methodologies.
• Responsible for monitoring electronic contract files and ensuring Plans are adhering to current policies and procedures for records management.
• Demonstrates ability to maintain focus and professionalism in fast-moving and changing environments.
• Effectively and professionally communicates to all parties concerned the pertinent information required to execute quality services.
• Responsible for escalating requests contrary to established business processes or contract language for resolution.
• Knowledge of Managed Care concepts.
• Demonstrates ability to work independently.
• Supports the Plan, Shared Services, Credentialing, Configuration, and Provider Enrollment Services in the investigation of provider data, and credentialing relating to contracts.
• Researches and communicates results of conflicting data and documents and takes action according to policy and procedures.
• Completes requests for research within time period specified by Department standards.
• Identifies and reports compliance issues in accordance with Plan policy and procedure.
• Demonstrates a functionally working knowledge of Facets or other claims systems, including the contract management and provider data software, and routinely relays information about contract corrections to the Network Strategy department.
• Works with all departments to develop and execute AmeriHealth and Plan strategies as needed.

Administrative responsibilities

• Performs other duties and projects as assigned.
• Adheres to Plan policies and procedures.
• Attends required training sessions on as required.

Skills

• 3 years of Medicaid experience preferred; 1 year in a Provider Services position.
• 5 years in the managed care/health insurance industry preferred.
• Previous experience working with healthcare providers. Previous provider relations experience preferred.
• Superior systems navigation skills (e.g., ability to toggle, work in multiple systems, navigate keyboard shortcuts, and exercise intuitive ability when navigating systems) preferred
• Excellent knowledge of contract administration.
• Excellent knowledge of provider record management.
• Superior ability to work independently and manage projects.
• Strong assessment and problem-solving skills.
• Proficient with office software applications (e.g., Excel, Microsoft Office Suite of products).
• Ability to prioritize and manage multiple tasks simultaneously.
• Detail oriented.
• Excellent verbal and written communication skills. Proofreading letters, contracts, memos, and reports to maintain a 95% accuracy rate.
• Effective interpersonal skills.
• Effective organizational skills.
• Effective project management skills
• Effective presentation skills
• Effective leadership skills.