Contract Administrator

October 14

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The Princess Margaret Hospital

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201 - 500

Description

• Responsible for sustaining and building assigned network with full panel of Primary Care Physicians and Specialists. • Identify network needs and negotiate full agreements and Memorandums of Understandings with providers to ensure availability and accessibility for members. • Produce contract documents with various reimbursement payment methodologies such as Fee for Service, Capitation, Flat rates, and Case Rates. • Conduct remote and field physician recruitment, negotiations, and servicing while partnering with managed care conscious providers. • Coordinate with Medical Management and Network Management in processing provider adds and terminations. • Support credentialing process by collecting documents for new and recredentialing applications.

Requirements

• Document redlining and collaboration with legal team • Determine financial responsibility • Knowledgeable of claims, authorizations, network management, credentialing and eligibility processing and DOFRs/FRMs • Knowledgeable of Medicare and Medicaid fee schedules • Represent company vision and goals during field visits and onsite engagements • 5 years managed care physician contracting negotiations • Four year college degree or higher or equivalent experience • Financial review and contract performance • Capitation compensation negotiations and implementation