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Contract Specialist - (Manage Care /Behavioral Health /Provider Relations) in Woburn, MA at Beacon Health Options

Date Posted: 3/7/2019

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic Contract Specialist to join our team at our office in Woburn, MA. The Contract Specialist identifies and recruits providers to fulfill Beacon Health Options network needs.  Duties include identifying and contracting new/ re-contracting existing providers around Beacon’s need for services, negotiating rates, drafting provider services and facility agreements, sending and receiving credentialing applications, overseeing the resolution of language changes and securing executed contracts with providers, developing recruitment plans and reports and ensuring rates negotiated are within established guidelines.

Position Responsibilities:

  1. Negotiates rates and contract terms with both new and contracted providers.

  2. In conjunction with internal and external stakeholders, secure executed agreements with identified out of network providers for inclusion in the Beacon Health network – Federal/Employer Division.

  3. Works closely with network analysts and other staff (e.g., credentialing) to assure client performance guarantees related to network access are met.

  4. Coordinates with various teams and departments (e.g., credentialing, network operations and regional network teams) to identify and close network gaps or meet client network recruitment requests. 

  5. Leverages a variety of tools (e.g., geo-access, customer requests, published provider directories) to identify and pursue provider recruitment to close network gaps.

  6. Identifies opportunities for cost savings and process improvements related to the contracting process.

  7. Review, draft and document suggested language changes, and oversee resolution of all proposed changes to the provider services agreement.

  8. Ensures that Contract Language is in compliance with plan agreements and within all state and federal regulatory and NCQA standards.

  9. Gathers, reviews and submits credentialing applications, as required, for network development and management.

  10. Supports audits by pulling contracts and validating rates for internal and external requestors

  11. Tracks and ensures accuracy of contact amendments, monitors rate increase requests and responds to provider requests for contracts and fee schedules.

  12. Provides general support to all network development activities and support Director with implementation requirements.

  13. Strategizes with other members of the management team to ensure access and availability of providers meets current standards.

  14. Collaborates with other departments to address and resolve operational issues as related to negotiated contract language.

  15. Prepares reports and analyze data as directed by the Director of Contracting or other members of the management team.

  16. Adheres to all Beacon policies and procedures and standards of operations.

  17. Completes all required and assigned trainings.

  18. Attends all mandatory company or department meetings.

  19. Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.

  20. Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.

  21. Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.

  22. Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.

  23. Assist team members and offers suggestions to improve processes, culture, or work environment.

  24. Performs special projects and other duties as assigned and required. 

 Position Requirements:

Education: High School diploma required.  Bachelor’s degree preferred or equivalent experience in health care field.

Relevant Work Experience:  

  • Minimum of 2-3 years’ experience in managed care ideally in provider relations, behavioral health organization or similar. Strong understanding of Physician reimbursement methodologies - behavioral health experience a plus.

Knowledge, Skills & Abilities:

  • Knowledge of managed care contract requirements to include state and federal regulatory requirements for Medicare and Medicaid plans and CMS guidelines.

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

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