Contract Specialist - Ambulatory Admin - Med Ops - Braintree - job 636268

Tufts Medical Center

Date: 02/23/2021

City: Braintree, Massachusetts

Employment type: Full-time

Company Description



It takes a lot of very smart, hard-working and talented people to provide the level of care that we give to our patients. Tufts Medical Center is an internationally respected academic medical center and we pride ourselves not only on the sophistication of the care we deliver, but the compassionate way in which we provide it. And that starts with our employees.



Job Description




Under the direction of the Director of Contracting, the Contract Specialist is responsible for managing relationships with payers and Local Care Organizations (LCOs). The Contract Specialist will provide accurate and thorough information regarding fee schedules and implementation, products and product changes, and contract measures and metrics, including those pertaining to quality and efficiency. In addition, the Contract Specialist will be responsible for the resolution of questions or concerns from both payers and LCOs, as well as for internal constituents through operations support and management of Single Case Agreements and submission of facility credentialing/re-credentialing applications.


The Contract Specialist must be well-organized and be able to access and communicate key features of existing contracts. The overall goal of the Contract Specialist should be to build and foster relationships between NEQCA, Tufts MC and payers and LCOs by providing a high level of proactive communication and service. This position will have a key role in building relationships that will promote the growth and success of the system.


 


PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:



  • Responsible for communications to the LCO network regarding fee schedule updates, contractual requirements, product changes and notifications pertaining to contract negotiations.

  • Provide key data in support of financial arrangements with health insurance plans.

  • Responsible for working with Informatics, Finance and Local Care Organization stakeholders to ensure communication of key objectives and responsibilities to support contract negotiations.

  • Support contracting initiatives in accordance with NEQCA business requirements, quality incentive programs and unit cost trend budget requirements.

  • Ensure new rates for health plan agreements are successfully communicated within the organization. Ensure that contracts are properly reviewed, executed and uploaded into the contract database.

  • Ensure that health plans are compliant with rate loading and other operational terms in accordance with contract effective date.

  • Work effectively with multiple departments to ensure that contracts are compatible with NEQCA/Tufts MC operations and structure.

  • Lead in the negotiation of Single Case Agreements with non-contracted payors while tracking and following to closure. Serve as the point of contact for Tufts MC departments.

  • Facilitate the review and submission of Tufts MC facility credentialing deliverables to payors.

  • Facilitate the review and submission of payer Center of Excellence applications for various Tufts MC specialties.

  • Participate in the monthly Tufts MC Operations workgroup and NEQCA Network Operations meetings.

  • Performs other similar and related duties as required or directed.




Qualifications




JOB KNOWLEDGE AND SKILLS:



  • Solid understanding of fee schedule development and implementation; demonstrated understanding of health care reimbursement methods and strategies.

  • Demonstrated ability to operate collaboratively as part of a team.

  • Strong written/verbal communication skills

  • Must be a highly self-motivated individual with the ability to function in a fast-paced environment with limited supervision and direction.

  • Must be able to handle multiple tasks and priorities.

  • Must be able to effectively translate between health plans and provider communities.

  • Must be a dedicated team player with the willingness and desire to learn and grow within the organization.


 


EDUCATION:



  • BS/BA in a relevant field required.

  • An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.



 


EXPERIENCE:



  • A minimum of three (3) years’ experience in managed care contracting, fee schedule implementation and reviewing of contracts; or an equivalent combination of education and experience.

  • Have strong communication skills with the ability to communicate clearly both verbally and in writing and be able to articulate complex ideas.

  • Be a self-starter who is accountable and requires minimal direction and supervision; a person who is open to new ideas; and a creative and flexible individual who is comfortable working in a large, complex organization.

  • Possess the personal characteristics of professionalism, credibility, commitment to high standards, innovation, discriminating judgment and accountability

  • An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.


 


LICENSES, ETC.:


  • N/A

 


WORKING CONDITIONS/PHYSICAL DEMANDS:



  • Work is in a fast paced office-based setting.

  • Reliable transportation is necessary. The NEQCA office is located in Braintree with travel to Local Care Organizations and community/tertiary hospitals.

  • Work often includes meetings outside of normal business hours




Additional Information




AMERICANS WITH DISABILITIES STATEMENT:


Must be able to perform all essential functions of this position with reasonable accommodation if disabled.


The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.


All your information will be kept confidential according to EEO guidelines.





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