MSO Healthcare Contract Specialist

Salary Estimate: $81848.00 - $122824.00 / year
Learn more about the benefits offered for this job.

The estimate displayed represents the typical salary range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. The typical candidate is hired below midpoint of the range.

Introduction

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for our Contract Specialist opening with HCA Healthcare today and find out what it truly means to be a part of the HCA Healthcare team.

Benefits

HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
  
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
  
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
  
• Family support through fertility and family building benefits with Progyny and adoption assistance.
  
• Referral services for child, elder and pet care, home and auto repair, event planning and more
  
• Consumer discounts through Abenity and Consumer Discounts
  
• Retirement readiness, rollover assistance services and preferred banking partnerships
  
• Education assistance (tuition, student loan, certification support, dependent scholarships)
  
• Colleague recognition program
  
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
  
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Job Summary and Qualifications

The Contract Specialist is responsible for understanding the terms of all HMO and PPO contracts, and at the direction of the Contracting Team, interface with health plans to negotiate HMO and PPO rates and Division of Financial Responsibility (DOFR).

This role is responsible for drafting and maintaining Network Provider agreements, at the direction of the President of SCCIPA and the Contracting Team.

This role is also responsible for co-leading the Contracts Governance Team which serves to inform and notify key PPMSI stakeholders about new/modified health plan contracts, including DOFRs, and new/modified provider agreements, and is considered the lead on implementation of such contracts to ensure functions such as Claims System Configuration, Customer Service, Utilization Management and Compliance are executing their assigned accountabilities.

This role is also accountable for co-leading the weekly Contracting Team meeting by preparing the agenda and open items for discussion and decision. The members of the Contracting Team include the CEO, CFO, President of SCCIPA, AVP Claims and Manager of Network Operations. We want you to apply!

What you will do in this role:

• Complete understanding of all contract terms, including the Division of Financial Responsibility
• When negotiating health plan contracts, accountable for reviewing and getting approval of the Division of Financial Responsibility (DOFR) from the President of SCCIPA and the CFO
• Accountable for drafting, reviewing and getting approval from the President of SCCIPA, any Network Provider or ancillary provider contract and its terms. Any deviation from standard terms requires financial analysis and additional approvals from the Contracting Team.
• Track assigned health plan termination dates, notifying the Contracting Team of upcoming renewal dates
• In conjunction with the CFO, finance team and Contracting team, provide analysis and recommendations for terms, sharing experience and market knowledge
• Provides interpretation of contract and DOFR terms to others in the organization to ensure contract is implemented and executed accurately
• May do analysis in conjunction with Finance or the Claims team to ensure claims payments are accurate, and participate in claims system configuration audits as needed
• Draft and prepare for review by the President of SCCIPA and CFO Letters of Agreement as directed
• Accountable for submitting monthly physician rosters to health plans based on Credentialing Committee approvals
• Accountable for storing and archiving agreements in a systematic, organized fashion

People

• Fosters an environment that promotes PPMSI Guiding Principles of Operational Excellence, Customer-Service Mindset, Equitable & Accessible Care, Respect & Compassion for All, A Trusted Partner to Physicians, a Trusted Partner in the Healthcare Journey for our members and supports a Growth Mindset for local, sustainable growth.
• Ensures a continuous learning organization, encouraging and promoting idea generation
• Builds trust and acts with authenticity
• Delivers information in a clear, concise and compelling manner
• Ensures strong sense of accountability amongst teams with measurable metrics, dashboard reporting and honest, timely performance feedback

What Qualifications you will need:

EDUCATION:

• Bachelor’s degree in Business or related field required

EXPERIENCE:

• Minimum 5 years equivalent work experience negotiating and managing contracts either in a health plan or IPA/MSO model
• Experience negotiating DOFRs, physician and ancillary agreements and Letters of Agreement
• Working knowledge of claims operations, credentialing process and overall MSO operations
• Minimum of three years of claims experience and/or one year of provider operations work required

CERTIFICATION/LICENSE:

• No license or certification requirements

Physician Services Group is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare’s graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder

If you find this opportunity compelling, we encourage you to apply for our Contract Specialist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.