Contract Manager
Requisition ID
36845
Department
Administration
Location
San Marcos,
California
Union
Not Applicable
Salary Range
40.30 - 63.87
Job Type
Full-Time
Shift
Day
Hours Per Shift
8
Hours Per Pay Period
80
Description
The Contract Manager is responsible for the development, negotiation, and maintenance of healthcare contracts. Key factors include assertively supporting Palomar Health Medical Group's growth by developing new contracts with payers and expanding services with existing contract payers. The Contract Manager is responsible for the entire contract process from pre-contract to post-signature phases, and closely collaborates with the Senior Director, Managed Care and Business Development, to ensure that appropriate staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers we serve.
Ability to speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the first two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health Medical Group rules, policies, procedures, applicable laws, and standards. Carries out the mission, vision, and quality commitment of Palomar Health Medical Group.
Essential Functions
Develop, negotiate, and maintain contracts with all payers including researching territories to identify gaps with our payer base and supporting the expansion into new markets, actively participate in establishing strategic business goals with the Leadership Team, assure contractual arrangements meet financial targets and legal/regulatory compliance requirements with an emphasis on analyzing cost and utilization data, facilitate the approval process of all contract documents from pre-contract through post signature phases, responsible for the accuracy of supporting documentation for contracts and completing documents accurately, develop and maintain processes that provide timely notification of critical contract events, maintain existing relationships with contracted providers, ensure contractual language is kept current, evaluate fee schedules on a yearly basis to identify possible opportunities for additional covered services, medical policy changes, and reimbursement, coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy and billing policies, conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals and objectives, develop and maintain periodic reports on the status of all contracts, assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes, maintain excellent written and verbal communication with all internal and external customers, effectively and professionally represent Palomar Health Medical Group to the provider community, assist with all contracting administration and other projects, as needed or assigned.
Customer Service:
1. Timely, professional responses to internal and external clients.
2. Handles all staff and providers in a professional and friendly manner
3. Processes paperwork in a timely manner
Compliance:
1. Must maintain confidentiality
2. Annual reporting and auditing
The above is not intended to be an all-inclusive list of essential functions for the job described, but rather a general description of some of the responsibilities necessary to carry out the duties of this position.
Ability to speak and read English at a level that is sufficient to satisfactorily perform the essential functions of the position. Knowledge of standard office equipment (i.e., calculator, fax, photocopier) and personal computer and computer software skills (i.e., MS Windows, Excel, Access, Word, PowerPoint, internet, e-mail). Windows computer skills including proficient use of keyboarding, use of mouse or keys for functions such as selecting items, use of drop-down menus, scroll bars, opening folders, copying and similar operations required upon employment or within the first two weeks of employment to perform the essential functions of the job. Performs other duties as assigned. Follows Palomar Health Medical Group rules, policies, procedures, applicable laws, and standards. Carries out the mission, vision, and quality commitment of Palomar Health Medical Group.
Essential Functions
Develop, negotiate, and maintain contracts with all payers including researching territories to identify gaps with our payer base and supporting the expansion into new markets, actively participate in establishing strategic business goals with the Leadership Team, assure contractual arrangements meet financial targets and legal/regulatory compliance requirements with an emphasis on analyzing cost and utilization data, facilitate the approval process of all contract documents from pre-contract through post signature phases, responsible for the accuracy of supporting documentation for contracts and completing documents accurately, develop and maintain processes that provide timely notification of critical contract events, maintain existing relationships with contracted providers, ensure contractual language is kept current, evaluate fee schedules on a yearly basis to identify possible opportunities for additional covered services, medical policy changes, and reimbursement, coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy and billing policies, conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals and objectives, develop and maintain periodic reports on the status of all contracts, assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes, maintain excellent written and verbal communication with all internal and external customers, effectively and professionally represent Palomar Health Medical Group to the provider community, assist with all contracting administration and other projects, as needed or assigned.
Customer Service:
1. Timely, professional responses to internal and external clients.
2. Handles all staff and providers in a professional and friendly manner
3. Processes paperwork in a timely manner
Compliance:
1. Must maintain confidentiality
2. Annual reporting and auditing
The above is not intended to be an all-inclusive list of essential functions for the job described, but rather a general description of some of the responsibilities necessary to carry out the duties of this position.
Job Requirements
| Minimum Education: | Bachelor's Degree Healthcare Management or related field or equivalent combination of education and experience |
| Preferred Education: | |
| Minimum Experience: | 3 years relative experience with hospital, medical group, clinic, physician and/or primary care and health system contracting |
| Preferred Experience: | |
| Required Certification: | |
| Preferred Certification: | |
| Required License: | |
| Preferred License: |
We are an equal opportunity employer and do not discriminate against applicants or employees based on race, color, gender, religion, creed, national origin, ancestry, age, disability, sexual orientation, marital status or any other characteristic protected by law.