• Contract Oversight Specialist

    Job Locations US-RI-Providence
    Req No.
    2018-9506
    Department
    Provider Network Management
    Type
    Regular Full-Time
  • Overview

    The Contract Specialist serves as Neighborhood’s liaison with the provider and vendor community for the interpretation of contract language, financial, and operational aspects of contracts and performance management including accreditation and regulatory requirements. The position requires in-depth knowledge contract requirements; technical and analytic skills, ability to interpret contracts and requirements, and financial skills to ensure all aspects of a contract are implemented and managed throughout the life of the contract.

    Responsibilities

    • Analyze and, in collaboration with the Office of the General Counsel, interpret contractual, legal, regulatory and legislative provisions to ensure contracts meet compliance
    • Oversee implementation of financial and operational contract terms
    • Serve as a the subject matter expert (SME) on new and current provider contracts
    • Understand and interpret provisions and obligations in the organization’s contracts and provider contracts
    • Alternative Payment Strategy position serves as a key contact and interface for Medicaid Accountable Care Entities (AEs). Oversees key AE program elements including AE Incentive Performance Program and MCO Incentive Improvement Program reporting; Staff support for Neighborhood Internal AE Work Group and for AE Joint Operating Committee.
    • Understand, interpret and manage all requirements for National Committee for Quality Assurance (NCQA) for the department
    • Coordinate and communicate with internal departments to exchange information related to contract implementation activities in a timely and accurate manner
    • Coordinate departmentally and inter-departmentally to ensure resolution and communication of contractual issues
    • Create and maintain language requirements for provider contracts
    • Identify and implement medical expense savings opportunities
    • Initiate and participate in department/team projects as necessary
    • Oversee the ongoing management of contractual provisions including coordination with the Compliance Department
    • Participate in external meetings with provider network to address issues and/or provide ongoing consultation
    • Participate in internal and cross-functional meetings/projects as assigned
    • Prioritize and organize all work to meet deadlines
    • Review proposed contracts and make recommendations based on comprehensive knowledge of existing contracts, reimbursement methodologies, system and operational procedures
    • Review, analyze and interpret provider reports to oversee and monitor compliance with contractual provisions
    • Synthesize information from multiple sources to understand and interpret findings relative to business needs and objectives
    • Understand the intent of contract language and develop approaches to implementation of new or existing agreements
    • Responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents
    • Other duties as assigned

    Qualifications

    Required:

    • Proven knowledge across areas of government markets, finance, risk models and contracting language (e.g., health care laws, CMS Federal and state regulations)
    • Must be a highly motivated with the ability to identify, understand, research, and solve unique and complicated financial and operational provider issues
    • Requires the ability to understand and interpret all aspects of a contract with an emphasis on the implementation and operational components of contract terms
    • Must recognize and take into account the broader business, operational and financial impact of focused, department-specific initiatives, analytic questions and/or decisions
    • Requires the ability to work in a fast paced environment balancing multiple priorities and utilizing resources aggressively
    • Excellent interpersonal skills are required to develop and maintain strong working relationships with internal and external contacts
    • Must be able to work cooperatively as a team member
    • Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)
    • Ability to manage multiple projects simultaneously
    • Ability to manage data and processes in multiple platforms
    • Resilient, collaborative, flexible, innovative
    • Experience with commercial, Medicaid or Medicare contracting and reimbursement
    • Ability to manage multiple projects simultaneously
    • Ability to work independently
    • Detail oriented, with the ability to organize and manage multiple priorities
    • Excellent customer service skills
    • Excellent written and strong business communication skills (written and verbal) public relations, presentation and facilitation skills
    • Strong operation management knowledge and analytic capabilities
    • Bachelor’s degree in Health Administration, Business Administration, Public Health or a related field or an equivalent amount of education and experience
    • Two (2)+ years’ experience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare)

    Preferred:

    • Experience in an Accountable Care Organization (ACO)

    Organizational Competencies:

    • Judgment and Decision Making
    • Gets Results
    • Collaboration and Teamwork
    • Business Awareness
    • Customer Focus

    Job Specific Competencies:

    • Problem Solving/Analysis
    • Planning & Organizing
    • Open Communication
    • Relationship Building & Networking
    • Flexibility & Achieving Change

    Travel Expectations:

    • Ability to travel including reliable transportation, a valid driver’s license and proof of insurance

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

     

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org.

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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