Contract Implementation Specialist

2 days ago

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Peak Health

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Health Insurance • Managed Care • TPA Services • Pharmacy Benefit Management • Third Party Administrator

51 - 200

Description

• Plays a critical role in development and implementation of an efficient network for our members. • The Contract Implementation Specialist performs duties to support contracting and has responsibilities in loading and auditing contracts to ensure the Peak Health Network meets or exceeds access, quality, and financial goals across all product lines in the market. • Maintenance and coordination of contracting documents and any contracting databases. • Supports contracting initiatives in accordance with Peak Health business and budget requirements. • Ensure new contract terms for agreements are successfully communicated within the organization. • Prepares, sends, and receives provider documents, including contracts, amendments, addendums, and correspondence to grow and maintain all Peak Health product lines across multiple markets. • Summarizes offers for review with appropriate Peak Health committees and individuals. • Communicates the implementation of new and renewal contracts to upper management and monitors the reimbursement to ensure accurate payment of claims by Peak Health. • Audits large volumes of data and conducts in-depth quantitative analysis of results and evaluates trends. • Maintains contract files for Peak Health.

Requirements

• Bachelor’s degree in Business Administration, Health Care Management or other related Business field. • Five (5) years’ experience in healthcare or insurance environment. • Solid understanding of fee schedule development and implementation; demonstrated understanding of health care reimbursement methods and strategies. • Progressive experience in health care management, physician groups, hospitals, payer contract negotiations, legal reviews of contract, or contact management preferred. • Experience with provider data management and contract management software.