Provider Contract Specialist

Provider Contract Specialist

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Provider Contract Specialist to perform a variety of technical tasks related to the planning, development, negotiation, coordination and monitoring of HPSM provider contract activities; make program-related decisions; ensure contracts meet regulatory criteria; and establish basic program policies and coordinate functions with other HPSM departments.

The essential duties and responsibilities will include the following: 

• Collaborate with business owners to develop provider contracts.
• Coordinate and monitor provider contract functions.
• Work collaboratively with departmental staff and other agencies/participants involved in the contract development and approval process.
• Assist Health Services and Provider Services in the creation of single case agreements and LOAs.
• Support provider outreach to non-contracted providers who have frequent LOAs with HPSM, to initiate contracting.
• Provide recommendations on improving provider contract management systems, and implement improvements to existing contract management systems.
• Maintain a contract review process; coordinate the regular review of contract expirations, renewals, and amendments.
• Serve as a resource to HPSM staff when questions arise over contract details; provide training to other departments regarding the contract process and departmental procedures, as needed.
• Assist Finance Staff in the preparation of Purchase Orders and invoice validation.
• Professionally represent HPSM in internal and external meetings.

• Perform other duties as assigned

Requirements

Education and Experience: Bachelor's degree in business, healthcare policy/administration, or a related field.  Two (2) years’ experience in health care or health insurance contract coordination.  Experience developing provider contract strategies based on cost-benefit analysis, research, and competitive analysis.

Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint.  Health care delivery systems, models, and health care industry practices.   Contract development.  Information management systems.   Specific knowledge of Medi-Cal Managed Care is desired, but not required.

Ability to: Work cooperatively with others.  Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing.  Adapt to changes in requirements/priorities for daily and specialized tasks.  Communicate, interact, and collaborate effectively with a wide range of internal and external customers.  Review contracts, policies, and procedures to ensure accuracy and identify inconsistencies or risks. Propose contract revisions to mitigate risks or improve the clarity of contract requirements. Analyze issues and make appropriate decisions.  Update and/or create databases and contract maintenance systems and processes.  Communicate effectively, verbally and in writing.  Perform work with meticulous attention to detail. Organize and prioritize tasks and deliver results within set deadlines.  Use a computer with proficiency, including Microsoft Office Suite applications (Outlook, Word, Excel, and PowerPoint).  Learn how to use new applications and information systems as needed.  Establish and maintain cooperative working relationships with a variety of people.

Compensation and Benefits

Starting Compensation Range: - Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage.  Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits.  Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.