Contract Operations Specialist - 25-164

We’re delighted you’re considering joining us!

At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

We are seeking a highly motivated and experienced managed healthcare Contract Operations Specialist to join our team in Northern California. Reporting to the Manager of Contract Policy and Operations, this role requires a skilled professional with in-depth knowledge of managed healthcare contract administration between IPAs, providers and health plans. The individual will join a team managing the end-to-end process of implementing health care contracts for commercial, Medi-Cal and Medicare Advantage HMO business, ensuring all contractual obligations are operationalized.

Key Responsibilities:

• Develop and sustain mutually beneficial relationships with health plan and provider representatives.
• Implement new and amended health care contracts. Ensure smooth onboarding and transition of contracts from initiation to full operational status.
• Work closely with internal teams including Legal, Compliance, Operations, IT, and Physician and Member Services to meet and maintain contractual requirements.
• Maintain commercial, Medicare and Medi-Cal HMO guidelines and Practice Operations Manual through review and content editing. Work with subject matter experts to clarify and address information gaps and discrepancies.
• Assist in developing training materials and provide ongoing education for internal staff regarding contract specifications, processes, and best practices for managing contracts.
• Negotiate terms of managed care contracts with health care providers.
• Adhere to contract documentation processes using Salesforce and applicable systems.
• Identify potential risks and roadblocks in the implementation process. Work proactively to resolve issues and ensure that the project remains on track.
• Utilize advanced features of database and spreadsheet software to aid in project work, including ad hoc reporting.
• Other duties as assigned.
  
  
  

Education:

• Bachelor’s degree in Health Administration, Business Administration or related field, or any combination of academic education, professional training, and work experience that demonstrates the ability to perform the duties of the position.
  
  
  

Experience:

• Minimum of 3 years of experience with contract management or contract operations, within a health plan or other managed care environment.
• Understanding of the managed healthcare industry, including managed care principles and reimbursement mechanisms.
  
  
  

Skills & Competencies:

• Strong oral, written, and reading comprehension skills are required.
• Strong negotiation and communication skills, with the ability to influence and collaborate with various stakeholders.
• Demonstrated project management skills, including the ability to prioritize and accurately track multiple projects and tasks. Must be able to contribute to cross functional work groups both as leader and participant.
• Exceptional problem-solving and critical thinking abilities.
• Excellent organizational skills and attention to detail.
• Ability to conduct thorough research as it applies to contract language and operations.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint). Familiarity with SharePoint, Epic and Salesforce is beneficial.
  
  
  

Additional Information:

Salary: $85,000 - $90,000 Annual

Hill Physicians is an Equal Opportunity Employer