Responsibilities:

The Contract Specialist is responsible for building, and maintaining positive working relationships between their team, Plan and other stakeholders. The Contract Specialist ensures contract data and documents are represented correctly in all plan operating systems, functions as a pro-active contract administrator and coordinates resolution of contract administration issues relating to loading of contracts:

• Demonstrates a working knowledge and ability to explain AmeriHealth, Plan regulations, policies and procedures to relating to provider contracts. This requires the Contract Specialist to stay current with all updates and revisions.
• Responsible for auditing contract documents and provider records for completeness and accuracy.
• Responsible for managing and monitoring Excel reports for projects and other assignments. 
• Responsible for swiftly aligning contract documents to provider records in operating system with 95% accuracy.
• Responsible for swiftly creating contract records in the contract management system with 95% accuracy. 
• Responsible for provider contract management:
  • Demonstrates a functional knowledge of managed care provider types, contract types and reimbursement methodologies.
  • Responsible for monitoring electronic contract files and ensuring Plans are adhering to current policies and procedures for records management. 
  • Demonstrates ability maintain focus and professionalism in fast moving and changing environments.
  • Effectively and professionally communicates to all parties concerned the pertinent information required to execute quality services.
  • Responsible for escalating requests contrary to established business processes or contract language for resolution.
  • Knowledge of Managed Care concepts.
  • Demonstrates ability to work independently.
• Supports the Plan, Shared Services, Credentialing, Configuration and Provider Enrollment Services in the investigation of provider data, and credentialing relating to contracts.
  • Researches and communicates results of conflicting data and documents and takes action according to policy and procedures.
  • Completes requests for research within time period specified by Department standards.
  • Identifies and reports compliance issues in accordance with Plan policy and procedure.
• Demonstrates a functionally working knowledge of Facets or other claims system, including the contract management and provider data software and routinely relays information about contract corrections to the Network Strategy department. 
• Works with all departments to develop and execute AmeriHealth and Plan strategies as needed.
• Administrative responsibilities:
  • Performs other duties and projects as assigned.
  • Adheres to Plan policies and procedures.
  • Attends required training sessions on as required.

Education/Experience:

• High School/GED required. Bachelor’s Degree preferred.
• 3 years Medicaid experience preferred.
• 1 year in a Provider Services position.
• 5 years in the managed care/health insurance industry.
• Previous experience working with healthcare providers.
• Previous provider relations experience preferred.