DaVita Contract Specialist in Las Vegas, Nevada
HealthCare Partners- NevadaContract SpecialistOVERALL JOB PURPOSE
The function of this position is to provide support to ongoing contracting support for Corporate initiatives, including supporting contracting to ensure an
appropriate network to respond to the service needs for HMO membership in a mixed model environment. The Contract Specialist must have knowledge of
contract structure, basic state and Federal requirements, and ability to execute and process a contract.
MINIMUM JOB QUALIFICATIONS AND REQUIREMENTS
- Undergraduate degree in business or a health care related field preferred.
Three to five years of Managed Care experience to include
contract language negotiation and financial negotiation of
physician, facility and ancillary contracts.
Knowledge, Skills and Abilities:
Attention to detail
Must posses excellent communication skills
Must possess a valid Nevada driver’s license
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
Responsible for quality and continuous improvement within the job scope.
Responsible for all actions/responsibilities as described incompany controlled documentation for this position.
Contributes to and supports the corporation’s quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporation’s quality improvementefforts.
Obtains contract language, review comments and
recommendations and serves as a communication contract for contract language changes.
Coordinates involvement/approval of all contributing internaldepartments to structure design of contract.
Resolves pay or and provider problems throughout the contract negotiation process to ensure contract execution andimplementation. Able to answer pertinent questions from provider.
Identifies and investigates new contract opportunities. Collects due diligence background information on potential contracting parties.
Monitors contracts, prioritizes work flow and initiates, andcompletes contract re-negotiations, renewals
Coordinates with network Operations team at all phases ofnegotiation to ensure that contracts can be implemented and administered in compliance with contract requirements.
Maintains excellent documentation of ongoing contractnegotiation process including summaries of verbal discussion with internal and external parties.
Provides sufficient and timely follow-up to payers’ toprogressively move contract negotiations activity towards closure and execution
Maintains a strong understanding of health care/payer/provider industry and Health Care strategy of the Health System, andutilizes knowledge on the job by reviewing literature relevant to the marketplace and managed care health needs, maintaining contracts with applicable payer organizations.
OTHER JOB DUTIES AND RESPONSIBILITIES
+ Performs other work related duties and responsibilities asdirected, assigned or requested.
+ Must be able to research information, analyze financial data,exercise independent judgment, apply good organizational skills, and develop creative solutions to problems.
Must possess excellent communication skills.
Must be able to work in a collaborative fashion using negotiation skills.
Extensive knowledge of industry pricing mechanisms: Medicare based per diems. DRGs, global, case rates, and indexed feeschedules.
Ability to review financial data and manage financial information in order to identify and secure