Job Summary

The Senior Contract Specialist is a key contributor to the Contracting team. This position negotiates, develops, and maintains Letters of Agreements (LOAs), and healthcare services contracts which are moderately advanced to complex in nature; may also be responsible for Single Case Agreements (SCA), as assigned. Primary areas of focus include hospital systems and contracts with custom terms. This position also provides analytical, programmatic and project leadership for the department and serves as a resource throughout company for contract language and terms. This position maintains positive, effective relationships with contracted provider network with attention to ongoing service needs, as well as maintains effective relationships with internal departments impacted by contract changes. The Senior Contract Specialist identifies expense outliers, performs financial analysis, and recommends reimbursement strategies.

Essential Responsibilities

Contract and LOA Negotiation and Development

• Manage internal contracting process, LOA, and external network relationships for assigned providers and programs.
• Negotiate contract language and terms.
• Negotiate, coordinate, and produce Letters of Agreement and other provider contract documents.
• Build, maintain and leverage effective working relationships with external and internal constituents.

Financial Analysis and Reporting

• Perform and review financial analysis with Contract department leadership, Contracting leadership of assigned area and Finance staff.
• Perform advanced data gathering, analysis, and reporting in alignment with Contracting policies and procedures.
• Lead the development and analysis for key programs and provide recommendations based on analysis.
• Assist with the compilation of mandated reporting regarding contract payments.

Contract Administration

• Oversee the tracking and monitoring of contracts, LOAs, and related metrics; may also be responsible for SCAs.
• Ensure payments are made based on contract terms and assist with the facilitation of those payments as needed.
• Ensure all necessary contract information is directed to Provider Services staff for provider data file entry and maintenance.
• Assist in the resolution of provider issues related to contractual relationships.
• Coordinate accuracy and maintenance of provider payment networks with System Coordinators.

Project Leadership

• Provide program and advanced project leadership for assigned area to the Contracting department.
• Collaborate with internal departments and leadership to determine appropriate changes to existing programs; participate in the design of new programs and payment models.
• Create programmatic materials that educate the provider network and internal teams regarding changes to existing and new payment models.

Department Policies and Operations

• Play a critical role in developing and maintaining contract infrastructure and procedures based on management direction.
• Recommend provider payment and network strategies to the contract management team.
• Orient CareOregon staff to contracting process; act as an advanced resource to staff on contract-related matters.

Organizational Responsibilities

• 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 5 years' progressive experience in managed care contracting, provider relations, network/business development, or financial analysis/accounting with a minimum of 2 years in contract negotiation, development, and administration

Preferred

• Bachelor's degree in Business, Health Care Administration, Analytics, or related degree

Knowledge, Skills and Abilities Required

Knowledge

• Extensive knowledge of managed care and the Oregon Health Plan
• Strong 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), shared savings agreements, and ability to perform rate calculations
• Strong knowledge of data analytics tools and methodologies
• Knowledge of physician group, hospital, and facility operations

Skills and Abilities

• Excellent analytical skills

• Excellent written and verbal communication skills
• Strong word processing, spreadsheet, and database skills
• Ability to 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 complex reimbursement arrangements
• Ability to maintain professional relationships with internal staff and departments
• Ability to independently work with providers, provider groups and other populations in addressing and resolving problems
• 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, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): 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.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.