Pediatric Associates was founded in Hollywood, FL in 1955. The same clinician-led, evidence-based, medical home passion is a unifying driver for those who join Pediatric Associates Family of Companies. The Pediatric Associates Family of Companies is a growing team of Pediatricians and Pediatric Care Teammates who are excited to be part of the first nationwide Pediatric Primary Care Medical Home. We further our uniqueness by ensuring the clinician voice is leading our medical home innovations.
Remote Position
PRIMARY FUNCTION
The Enterprise Contract Specialist is responsible for monitoring, storing, and tracking all Enterprise payor contracts. This position is also responsible for all contract language reviews and will work directly with the PA Family of Companies legal team for language escalation outside the scope of previously approved contract terms. This position reports directly to the Senior Manager of Managed Care Operations.
ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all of the duties that may be assigned.
- Supports Sr. Manager of Managed Care Operations with contract proposal development, monitoring, and evaluation.
- Performs contract language reviews following PAFC previously approved language and collaborating with legal when needed to support in negotiating language changes/terms/provisions with payors to maximize reimbursement, reduce exposure, and streamline administration.
- Monitors and maintains contracts and contract overviews utilizing established procedures.
- In conjunction with the Data & Reimbursement Specialist, gathers and analyzes data and utilizes internal modeling for managed care contract negotiations.
- Identifies contracting opportunities with new and existing payor agreements.
- Reviews and maintains contract renewal schedule to ensure contracts are negotiated timely.
- Monitors the contract execution process to ensure proper records management.
- Ensures provider compliance with all market contract terms and legal regulations.
- Researches all state and federal regulations that may impact the performance of the contract.
- Other duties as assigned.
QUALIFICATIONS
EDUCATION:
- Associates degree required in Healthcare Administration or Business. Bachelor’s degree preferred.
- A minimum of 5 years of related experience will be commensurate with education.
EXPERIENCE:
- Minimum of 5 years’ of combined payor and provider experience required.
- Previous healthcare experience required.
KNOWLEDGE, SKILLS AND ABILITIES
- In-depth understanding of contract parameters, reimbursement methodologies, contract language and performance.
- Knowledge in Risk and Value Based Contracting
- Effective strategic planning and organizational skills
- Knowledge of Statewide Medicaid Managed Care programs and Commercial payors
- Proficient in research, analysis, and interpretation of financial data and trends
- Knowledge of reimbursement methodologies and CPT, ICD10, RBRVS, and capitation.
- Advanced Microsoft Office skills
- Effective oral and written communication and negotiating skills.
- Ability to manage multiple priorities and projects.
- Strong interpersonal skills
- Ability to influence others
TYPICAL WORKING CONDITIONS
- Non-patient facing
- May be either full time remote or rotate working in the office.
- Must be U.S. based.
- Indoor Work
- Operating Computer
- Reach Outward
- Reach above Shoulder
- Lift/Carry 11-20lbs.
- Standing
- Sitting
- Traveling
- Walking
- Bending
- Manual Dexterity
OTHER PHYSICAL REQUIREMENTS
- Vision
- Sense of sound
- Sense of touch
PERFORMANCE REQUIREMENTS
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.
The Pediatric Associates Family of Companies an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.