Specialist, Provider Contracting Operations

The Provider Contracting Operations Specialist will assist with maintaining all contract templates, policies and procedures, and coordinate the delivery of documentation with other business units to ensure cohesion.

Assist with reviewing and delivering onboarding provider data.

Work closely with the Provider Contracting department to assist with various tasks to ensure consistency is taking place across the department deliverable
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This position is 100% Remote.
\nWith approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island.

Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services.

Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare.

For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care.

We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives.

Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.Minimum Education:


* Associates degree or five years of relevant contract negotiation or operations experience required.


* Bachelor's degree in Business Administration or similar field of study preferred.

Minimum Experience:


* Contracting administration and negotiations in a managed care environment required.


* Excellent verbal and written communication skills.


* Detail oriented and analytical.


* Strong organizational skills.


* Ability to manage multi-level and complex organizational structures.


* Managed Care operations and regulatory requirements for all lines of business.


* Industry knowledge of FFS and capitation contractual arrangements with Primary Care and Specialist providers.


* Knowledgeable of Commercial, Medicare, Medicaid lines of business

Req.

Certification/Licensure: None.Job Responsibilities/Duties


* Attend project strategy meetings as the SME and ensure deliverables are met and completed in a timely manner.


* Understand Provider Contracting's operational processes to develop policies, procedures, and training materials.


* Understand the organization's contracting system to draft, monitor, and maintain the Provider Contracting department's SOPs, policies, and job aides, and act as a SME to support the training of designated us...