Alignment Health
ProviderContractSpecialist
“Provider Contract Specialist at Alignment Health. Skills: provider contracting, network development, negotiating contract terms, managing contract data. Recruit new providers in assigned specialty(ies) and regions to support CMS network adequacy and expansion goals. Draft and implement contracts in accordance with department guidelines with physicians and/or ancillary providers to support existing and developing markets”
What You'll Achieve.
support the growth and performance of our provider network; owning the process from initial outreach through signed agreement; support CMS network adequacy and expansion goals; ensure timely contract execution and network participation; ensure accurate provider directories, Alignment systems, and internal stakeholder awareness
Industry & Context.
analytic, quantitative, and problem-solving skills required
Approximately 20% local provider office visits, Mileage reimbursement, Maintain reliable means of transportation, Valid driver’s license, Automobile insurance, Drives approximately 20-60% of the time to provider sites, Travel by plan required as needed to support provider services needs in other geographies, Regularly required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or and reach with hands and arms, Frequently lifts and/or moves up to 10 pounds, Specific vision abilities required by this job include close vision and the ability to adjust focus
What They're Looking For.
Must Have
Minimum 5 years’ experience in provider relations / contracting with an HMO or IPA, medical group or institutional provider required, High School Diploma or GED, analytic, quantitative, and problem-solving skills required, verbal and written communication skills required, presentation skills and ability to appropriately and effectively address diverse audiences required, Maintain reliable means of transportation, valid driver’s license, automobile insurance
Nice to Have
Bachelor's degree or four years additional experience in lieu of education, Access database proficiency preferred
What You'll Do.
Recruit new providers in assigned specialty(ies) and regions to support CMS network adequacy and expansion goals
Draft and implement contracts in accordance with department guidelines with physicians and/or ancillary providers to support existing and developing markets
Review Letters of Interest and distribute to the Contract Manager per department guidelines
Secure patient specific Letters of Agreement for non-contracted providers when requested by UM or Market Leadership
Prepare and maintain contract documentation and supporting materials to ensure accuracy
Request and obtain necessary credentialing information/documents for new providers and monitor credentialing status to ensure timely contract execution and network participation
Populate and maintain the contract tracker by promptly and accurately entering key contractual information
verifying data for accuracy and completeness
and ensuring records are consistently up to date
Serve as resource for internal customers for provider contracting questions
ensuring timely professional and effective communication
Ensure overall compliance by responding to grievances/appeals and adhering to regulatory and departmental Policy and Procedure guidelines and timeframes
Process and communicate provider network changes
and contractual risk changes in a timely manner to ensure accurate provider directories
and internal stakeholder awareness
Participate in interdepartmental meetings and committees to support Network Management initiatives and organizational objectives
Contribute to departmental goals by supporting team initiatives and performing other related duties as assigned
Other duties and projects not listed above
How You'll Work.
Team & Collaboration
collaborating with internal teams including claims, clinical, and network management; Serve as resource for internal customers for provider contracting questions; Participate in interdepartmental meetings and committees to support Network Management initiatives and organizational objectives; Contribute to departmental goals by supporting team initiatives
Communication Scope
verbal and written communication skills required; presentation skills and ability to appropriately and effectively address diverse audiences required; effective communication
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