We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Senior Contract Administrator is responsible for sustaining and building assigned network with full panel of ancillary providers. Identify network needs and negotiate Ancillary Contracts and Memorandums of Understanding (MOUs) with providers to ensure availability and accessibility to members. Produce contract documents (fee for service agreements, capitation agreements, MOUs) and ensure timely turn around. Negotiate stat contracts with non-contracted providers.

Job Responsibilities/Duties

• Maintain ancillary network for all Prospect owned and managed IPAs for both full risk and non-full risk lines of business as well as Prospect Health Plan including, but not limited to DME, Lab, Radiology, ASC, Urgent Care, Home Health, SNF, etc. Negotiate new agreements or amend existing agreements as necessary to fulfill companywide new business objectives, new lines of business, etc. Identify network needs and fill network gaps by negotiating ancillary contracts and MOUs with providers. Prepares and submits requests for financial analysis to finance department in preparation for negotiating new capitated contracts or when renegotiating existing contracts. Upon termination of existing ancillary provider reviews network to ensure there are other contracted providers in the specialty or service category, ensures a termination acknowledgement letter is sent, if needed, negotiates contract with new provider. Oversees follow up for return signed contracts, amendments and/or credentialing applications, works with credentialing department as needed to obtain credentialing documents, upon completion of credentialing process presents contracts for execution.
• Audits CDA to ensure executed contracts and amendments are accurately entered. Creates and submits electronic change forms for new agreements, amendments, terminations, demographic changes, new tax ID numbers, revisions to agreement, etc. Ensures contract summaries filed on the K drive contain accurate contract information. Maintain ongoing relationship with ancillary providers to ensure smooth implementation and operations of agreement. Receives and responds to calls from assigned network providers, provides customer service to network providers by responding to contracting inquiries, requests for reimbursement increases, claims issues, credentialing issues, etc. Attends JOCs for contracted providers, and initiates meetings with existing and new providers.
• Review new Letters of Interest to determine need for network gaps. Maintain current ancillary provider network roster at all times. Provides network information for health plan auditing purposes.
• Provides customer service for internal, as well as, outside inquiries by providing clarity on contractual arrangements and reimbursement structures. Reviews weekly CDA reports to ensure contracts are accurately loaded and turnaround times are being met. Completes and/or oversees special projects, mass amendments and other assignments as needed or as assigned.

Qualifications

Minimum Education: Four (4) year college degree required.

Minimum Experience: Three (3) years of contracting experience related to healthcare and sales negotiation experience required.

Req. Certification/Licensure: None.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/