The Contract Specialist is responsible for providing a broad range of managed care contracting services for Gundersen Health System. This position is responsible for managing the preparation, compliance, development, maintenance and changes of Managed Care contractual arrangements, to include agreements with Insurance Carriers, Third Party Administrators and Direct Employer Groups. Collects internal data and information to analyze, evaluate and facilitate administrative follow-up to the financial, operational, and delivery aspects of managed care contracts. Participates in the negotiation process as requested by Director.
- Coordinates and prepares required documentation and information in order to analyze and evaluate the financial and administrative impact of managed care arrangements; identifies financial and administrative issues with respect to corporate goals and objectives for the purpose of achieving peak contract performance.
- Assists the Director in the evaluation, interpretation, negotiation and revision of contracts, letters of intent, contract addendums and related contract materials.
- Monitors the financial performance of existing and/or future payer relationships using software programs and feedback from internal customers.
- Works with Director to develop and implement payer score cards. Provide feedback from score cards to payers.
- Assists Managed Care team members in preparation of quarterly Managed Care newsletter.
Assists Director and Gundersen Health System Administrative Directors in creation and maintenance of health system contracts for outreach services and bringing services to Gundersen Health System.
Develops and maintains processes to streamline contracting activity and communication of managed care arrangements for Gundersen Health System. This includes coordination with Patient Business Services and Provider Medical Management to ensure managed care contracts are implemented appropriately.
Researches, organizes and coordinates resolution regarding contractual issues in a timely manner including overseeing the process of contract renewal to ensure clean, workable, and appropriate contracts for Gundersen Health System.
As requested by Director, represents Department as interface with Gundersen Health System Departments, Regional Clinics or committees in facilitating communication of managed care arrangements.
Facilitates Administrative meetings with contracted Managed Care entities to address contract performance and operational issues. Coordinates with other Gundersen Health System Departments to participate in Administrative meetings as necessary.
Scope of the Job Age Specific Population Served Nonage Specific (N/A)
OSHA Category Category III - No employees in this job title have a reasonably anticipated risk of occupational exposure to blood and/or other potentially infectious materials. Position Qualifications Education and Experience: Required Bachelor's degree in Business or Legal or Finance or Healthcare Administration or a health related field
Work Experience: Required 5-7 years experience in managed care, business, legal studies, health or related field. Desired 1 year Experience in a managed care environment and managed care contracting. Skills: Required Ability to... Computer Systems/Software/Applications maintain proficiency in Microsoft Office Products (i.e. Word, Excel, PowerPoint, Illustrator, etc.) Computer Systems/Software/Applications excellent computer skills Computer Systems/Software/Applications data base development and management Coding/Billing/Insurance concepts of managed care and medical insurance terminology Communication compose materials such as detailed reports, work-related manuals, publications of limited scope or impact, etc., and/or make presentations outside the immediate work area. Comprehension understand complex problems and to collaborate and explore alternative solutions General - All Positions content and structure of contracts Organization organize thoughts and ideas into understandable terminology Reasoning/Decision Making problem solve Reasoning/Decision Making make decisions which have moderate impact on immediate work unit Desired Ability to...