Contract Specialist, Senior

Working Conditions

Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure

The Contract Specialist, Senior is a key contributor to the Contracting team. This position negotiates, develops, and maintains Letters of Agreements (LOAs), and healthcare services contracts which are moderately advanced to complex in nature; may also be responsible for Single Case Agreements (SCA), as assigned. Primary areas of focus include hospital systems and contracts with custom terms. This position also provides analytical, programmatic and project leadership for the department and serves as a resource throughout company for contract language and terms.

This position maintains positive, effective relationships with contracted provider network with attention to ongoing service needs, as well as maintains effective relationships with internal departments impacted by contract changes. The Contract Specialist, Senior identifies expense outliers, performs financial analysis, and recommends reimbursement strategies.

$90,225.00 - $

Bonus - SIP Target, 5% Annual

Current Care Oregon Employees:
Please use the internal Workday site to submit an application for this job.

• Manage internal contracting process, LOA, and external network relationships for assigned providers and programs.
• Negotiate contract language and terms.
• Negotiate, coordinate, and produce Letters of Agreement and other provider contract documents.
• Build, maintain and leverage effective working relationships with external and internal constituents.

• Perform and review financial analysis with Contract department leadership, Contracting leadership of assigned area and Finance staff.
• Perform advanced data gathering, analysis, and reporting in alignment with Contracting policies and procedures.
• Lead the development and analysis for key programs and provide recommendations based on analysis.
• Assist with the compilation of mandated reporting regarding contract payments.

• Oversee the tracking and monitoring of contracts, LOAs, and related metrics; may also be responsible for SCAs.
• Ensure payments are made based on contract terms and assist with the facilitation of those payments as needed.
• Ensure all necessary contract information is directed to Provider Services staff for provider data file entry and maintenance.
• Assist in the resolution of provider issues related to contractual relationships.
• Coordinate accuracy and maintenance of provider payment networks with System Coordinators.

• Provide program and advanced project leadership for assigned area to the Contracting department.
• Collaborate with internal departments and leadership to determine appropriate changes to existing programs; participate in the design of new programs and payment models.
• Create programmatic materials that educate the provider network and internal teams regarding changes to existing and new payment models.

• Play a critical role in developing and maintaining contract infrastructure and procedures based on management direction.
• Recommend provider payment and network strategies to the contract management team.
• Orient Care Oregon staff to contracting process; act as an advanced resource to staff on contract-related matters.

• Minimum 5 years’ progressive experience in managed care contracting, provider relations, network/business development, or financial analysis/accounting with a minimum of 2 years in contract negotiation, development, and administration

• Bachelor’s degree in business, Health Care Administration, Analytics, or related degree

• Extensive knowledge of managed care and the Oregon Health Plan
• Strong knowledge of federal Medicare regulations and state Medicaid rules (OARs)
• Knowledge of claims administration and ability to implement contract reimbursement terms
• Knowledge of the Resource-Based Relative Value Scale (RBRVS), Diagnosis Related Groups (DRGs), shared savings agreements,…