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Medical Contracts Specialist

Orange, CA

Order: 192223
Temporary

Eastridge is seeking a Contracts Specialist for a client, a medical group located throughout the Orange County, CA area. You will be responsible for negotiating Memorandum of Understanding (MOUs), maintain and update Contracting Database Application of contracted providers, act as liaison with various internal departments to facilitate and resolve claim, system, customer service, and other related issues. Provide support to Provider Contracting Department.


Job Responsibilities/Duties

  • Negotiate and draft agreements and amendments outlining contractual terms.
  • Load contracts and amendments in Contracting Database Application (CDA) and routes electronic Change Forms to implement contracts or amendments.
  • Assist in Managing Claims Inquiries Box and Referral Que.
  • Negotiate MOUs as needed to provide contracts for referrals to non-contracted providers and secure savings on claims for retro dates of services.
  • Provide clarification on contractual arrangements to internal departments, providers, and billing companies.
  • Follow up for the return of signed contracts, amendments, or credentialing applications.
  • Works with the credentialing department as needed to obtain credentialing documents, upon completion of the credentialing process presents contracts for execution.
  • Audits CDA and Contract Summaries to ensure executed contracts are accurately entered.
  • Creates and submits electronic change forms for new agreements, terminations, demographic changes, and new tax identification numbers.
  • Receives calls from assigned network providers, provides customer service to network providers by responding to contracting inquiries, claim questions, credentialing issues.
  • Calculate cost savings by comparing contract rates to billed charges or non-contracted rates, whichever applies.
  • Documents all cost savings on the Cost Savings report.
  • Outline requested contract terms and completes Financial Impact Analysis forms and submits to Decision Support to perform analysis and presents for approval.
  • Supports Contract Administrators and Department by drafting contracts, updating contract summaries, updating CDA, generating reports as requested.
  • Performs other duties as needed, and as assigned.


REQUIREMENTS:

  • Two (2) years experience in contract negotiations in the healthcare or managed services industry.
  • Experience negotiating medical contracts with providers and doctors
  • Understanding of MOU
  • Effective understanding of Medical Terminology within a professional environment


Eastridge is an equal opportunity employer.


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