Provider Contracts Specialist

On Lok • San Jose, CA

1d

About The Position

On Lok PACE We are a non-profit committed to our participants. Dedicated to The Care of Elders: PACE ( P rogram of A ll-Inclusive C are of the E lderly) was developed to answer the many problems around caring for frail seniors. The PACE model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in their community whenever possible. Seniors, their family members, and caregivers face many issues, including transportation to appointments, management of medications, coordination of medical care from different specialists, lack of social interaction, and ability to stay alone at home. On Lok PACE participants receive in home care services and transportation to a On Lok PACE center for primary medical care, social and recreational activities, and other senior care services. We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare. Join our team of leaders to begin a rewarding career! POSITION SUMMARY: Under the direction and supervision of the Provider Services Manager, the Provider Contracts Specialist negotiates and implements contracts with outside healthcare providers providing PACE services to On Lok Participants.

Requirements

• Associate's Degree in any field or equivalent experience
• 1-2 years experience in a managed care field working with payors/providers in contract negotiations
• Detail oriented accuracy.
• Ability to establish negotiating strategies that leads to successfully implementing contracts.
• Ability to establish priorities and goals including workflow/project management and organization skills.
• Strong communication skills, both oral and written.
• Familiarity with Microsoft Office including Excel, Outlook, and Word.
• Ability to learn proprietary database(s) such as electronic medical record and claims payment system.
• Frequent travel to provider locations in SF, Fremont and San Jose area.
• Maintain a professional image and attitude in regards to clients, visitors and co-workers.

Responsibilities

• Effectively negotiate and implement healthcare contracts with physicians/other professionals, nursing homes and ancillary (including ambulance, DME, home health/hospice, imaging, lab, RCFE) providers that meet reimbursement goals within approved authority limits.
• Develop and maintain working relationships with outside provider community for both existing provider network and potential new network providers.
• Effectively negotiate and implement individual letter of agreements within approved authority limits.
• Acts as primary point of contact for contract interpretation, and for contract dispute related to claims inquiry.
• Maintains working knowledge of PACE, DHCS and Knox Keene regulations pertaining to provider contracts.
• Maintains working knowledge of reimbursement methodologies related to Medicare and Medi-Cal such as RBRVS, PPS and lab/ambulance.
• Provides input and participates in strategic planning efforts.
• Maintain contract files both soft and hard copy format.
• All other reasonably related duties as assigned.

Benefits

• Medical, Dental, and Vision coverage
• Retirement Savings Plan 403(b) and Term Life/AD&D Insurance
• Flexible Spending Account, Commuter Checks, MLA scholarships, Employee Assistance Program (EAP)
• Pet Insurance and additional discounts
• Holidays (10 per year), vacation time, sick leave, and long-term disability insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 101-250 employees