Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

The Contract Specialist negotiates, develops, and maintains provider contracts throughout the state and region which are routine or moderately advanced in nature. This position serves as a resource regarding contract language and terms. This position builds and maintains positive, effective relationships with contracted provider network with attention to ongoing service needs, as well as with internal departments impacted by contract changes. The Contract Specialist identifies expense outliers, performs routine financial analysis, and recommends reimbursement ideas. Area of focus may be Provider Network Contracting or Value Based Contracting.

• Administer the internal contracting process and external network relationships for assigned areas. Work will be focused in one of the following areas:

• Provider Network Contracting:
  • Primary areas of focus include ancillary providers (lab, imaging, physical therapy), home health, vision, durable medical equipment, medical supplies, skilled nursing facilities, pharmacy benefit managers, and other organizations
  • Identify and contact potential providers for inclusion in network, including initiatives pertaining to member access and geographic expansion
  • Coordinate accuracy and maintenance of provider payments with System Coordinators
  • Perform and review routine to moderately advanced financial analysis with Provider Services Director and Finance staff

• Value Based Contracting:
  • Coordinate accuracy and maintenance of provider payments with Accounts Payable
  • Perform and review routine to moderately advanced financial analysis with Value Based Contracting Manager and Finance staff

• Learn and integrate federal and state regulations into contract language.
• Negotiate or assist in negotiating contract language and terms.
• Negotiate, coordinate, and produce Letters of Agreement and Memorandums of Understanding.
• Coordinate production and execution of contracts with Provider Services staff.
• Assist in the resolution of provider issues related to contractual relationships.
• Build and maintain effective working relationships with contracted provider network with attention to ongoing service needs.
• Participate in contracting and networking projects; may serve as lead role for small projects.
• Orient CareOregon staff to contracting process; act as a resource to staff on contract-related matters.
• Recommend provider payment and network ideas to contract management.

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 3 years' experience in health plan operations, including customer service, claims, contracting, provider relations, or network development

Knowledge

• Knowledge of managed care and the Oregon Health Plan
• Growing knowledge of federal Medicare regulations and state Medicaid rules (OARs)
• Knowledge of claims administration and ability to implement contract reimbursement terms
• Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), and ability to perform rate calculations
• Knowledge of physician group, hospital, and facility operations

Skills and Abilities

• Word processing, spreadsheet, and database skills
• Ability to learn and negotiate facility contract language and terms
• Ability to develop and maintain effective relationships with providers and provider groups
• Ability to achieve desired outcomes through effective use of negotiation skills
• Ability to negotiate and implement routine to moderately advanced reimbursement arrangements
• Ability to develop and maintain professional relationships with internal staff and departments
• Ability to work with providers, provider groups and other populations in addressing and resolving problems with assistance from management on complex issues
• Ability to work independently, organize, prioritize, and manage multiple projects

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to speak clearly for at least 3-6 hours/day

Working Conditions

Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

#Li-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.