Contracting Specialist

Contracting Specialist

Department: Provider Contracting

Employment Type: Full Time

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Reporting To: Sukanya Hegde

Compensation: $25.71 - $32.99 / hour

Job Title:

Contracting Specialist
Department:
Provider Contracting
About the Role: Astrana Health is looking for a Contracting Specialist. This role will report to our Director - Provider Contracting Operations and enable us to continue to scale in the healthcare industry.

• Supports contracting efforts and loading for provider contracts
• Negotiate Patient Specific MOUs
• Process, Load, and maintain contracts and providers in contracting database application
• Acts as liaison with various internal departments to facilitate and resolve claims, provider configuration, customer service, credentialing, and other related issues.
• Negotiate and draft LOA/MOU agreements outlining contractual terms as directed
• Draft provider terminations and other provider correspondences
• Initiate changes to internal departments for updates, health plan submissions, and member outreach as needed
• Load agreements and providers to contracting data application with all contractual terms and linkages
• Manage Inquiries email box and Referral Queue
• Provide clarification on contractual arrangements to internal departments, providers and billing companies
• Provides customer service to network providers and other internal departments by responding to contracting inquiries, claims questions, and credentialing inquiries, and provider configuration
• Problem solve inquiries regarding contract or provider setup
• Works with credentialing department as needed to obtain credentialing and re-credentialing documents
• Track and document tasks to completion
• Generate reports as requested
• Other duties as assigned

• Proven ability to prioritize and organize while ensuring attention to detail
• Work independently to ensure established turn around times and project deadlines are met
• Proficient in Microsoft Office Suite
• Working knowledge of DOFRs, Claims, Utilization Management, Network Management, Eligibility, CPT Coding, Diagnosis Coding and Medical Terminology
• Strong communication, critical thinking, problem resolution, and interpersonal skills
• Ability to read, comprehend, and interpret managed care contractual agreements

Required Education/

Experience:

• Three years contract negotiations in a managed care environment working with Medicare and Medicaid fee schedules
• Maintain confidentiality and adhere to all regulatory requirements as well as to policies and procedures
• Associates degree or equivalent education and experience

You're great for the role if:

• You have knowledge of Commercial, Medicare, Medicaid lines of business

• This is a remote position. The home office is located at 600 City Parkway West 10th Floor, Orange, CA 92868.
• This position requires coming into office at least once per month at our offices located in 1600 Corporate Center Dr., Monterey Park, CA 91754 and 600 City Parkway West 10th Floor, Orange, CA 92868. Additional in-office days may be required based on business needs or special projects.
• The total compensation target pay range for this role is $25.71 - $32.99 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affiantitative Action employer. We do not discriminate based upon race, religion, color, national (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need.

If you require assistance in applying for open positions due to a disability, please email us at humanre to request an accommodation.

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.