at Cook County Government in Chicago, Illinois, United States
Job Description
Job Posting:Jul 9, 2024, 8:00:57 PMClosing Date:Jul 24, 2024, 4:59:00 AMFull-timeShift Start Time:8:30A.M.Shift End Time:4:30P.M.
Posting Salary:COMPETITIVE SALARY
Organization:Health and Hospital Systems
Job Title
Provider Contract Specialist
Department
Health Plan Services
This position is exempt from Career Service under the CCH Personnel Rules.
Job Summary
The Provider Contract Specialist supports the auditing and configuration of new and existing provider, hospital, and ancillary contracts.Oversees the auditing and monitoring of service contracts. Provides essential expertise to resolve contract and contract data issues with providers, educate staff/providers on contract in-load process and policies, and collecting credentialing information and other provider data.
Typical Duties
Oversees demographic information, in-load, and auditing of provider data.
Maintains existing provider/hospital/ancillary demographic information; conducts audits as needed.
Validates participation in State's Medical Assistance Program for new and existing providers.
Conducts data analysis and project management support. Supports network expansion efforts.
Provides back-end SQL reporting needs for extracting workable info from Provider Databases such as provider and network counts.
Assist with provider credentialing/re-credentialing functions.
Manages distribution of internal reports related to network.
Understands and explains risk contracts.
Strategizes for membership growth and retention.
Provides training, mentoring and guidance to new team members.
Performs special projects as assigned or directed.
Identifies potential new Independent Practice Association (IPA) relationships for profitable growth.
Works closely with the Network Contracting staff regarding contracting and contract management inquiries.
Completes new provider orientation for all applicable product lines.
Conducts site visits to service providers, resolve issues, educate staff/providers on policies, and collect credentialing information.
Manage provider & credentialing databases through collection of group rosters
Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.
Identifies network gaps and shares information with Network Contracting
Performs other duties as assigned.
Minimum Qualifications
*Bachelor's degree in from an accredited college or university is required (Official transcript is required at the time of interview)
*Three (3) years of managed care contract administration experience is required
*Two (2) years of experience assisting with contracting functions is required
*Intermediate proficiency with Microsoft Word, Excel, and Power Point is required (MS Office testing will be administered, 70% minimum proficiency rate is required)
Preferred Qualifications
*Prior experience in procurement and/or supply chain management within healthcare is preferred
Knowledge, Skills, Abilities and Other Characteristics
Knowledge of healthcare service pricing and reimbursement methodologies
Knowledge of, or aptitude to learn, current policies and guidelines that affect contracts, pricing, etc. in the managed care environment
Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
Strong organization and interpersonal skills
Demonstrate attention to detail, accuracy, and precision
Ability to prioritize, plan and organize projects and tasks
Ability to work in a team-based environment to accomplish goals and objectives
Ability to demonstrate respect and sensitivity for cultural diversity in CCH work force and patient population
Ability to work autonomously to resolve issues in a timely manner
Ability to multitask in order to allow a continuation of workflow
Physical and Environmental Demands
This position is functioning within a healthcare environment.The incumbent is responsible for adherence to all hospital and department specific safety requirements.This includes but is not limited to the following policies and procedures:complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.
For purposes of the American with Disabilities Act, "Typical Duties" are essential job functions.
VETERAN... For full info follow application link.
COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER
