Contract Administrator

Responsible for sustaining and building assigned network with full panel of Primary Care Physicians and Specialists. Identify network needs and negotiate full agreements and Memorandums of Understandings with providers to ensure availability and accessibility for members. Produce contract documents with various reimbursement payment methodologies such as Fee for Service, Capitation, Flat rates, and Case Rates.

• Conduct remote and field physician recruitment, negotiations, and servicing while partnering with managed care conscious providers.
• Decipher financial models and determine budget impact while driving towards stipulated regional MLR targets.
• Coordinate with Medical Management and Network Management in processing provider adds and terminations.
• Negotiate agreements and amendments based on various payment methodologies such as Capitation, Fee for Service, Case Rate, and Flat Rates.
• Work with providers and coordinate with external and internal legal teams to ensure compliance and to obtain approvals for redlines.
• Conduct market analysis, in conjunction with Provider Contracting Ops team, for provider coverage and reimbursement requirements.
• Present negotiated arrangements to Network Management and/or executive leadership for approval and execution.
• Conduct rollout meetings for new capitated specialist agreements and establish and/or maintain JOC meeting cadence. May lead ongoing JOC and specialty cap provider servicing efforts.
• Coordinate with other business units to ensure communication is provided to all impacted internal departments and to network providers.
• Ensure system configuration set-up is complete in accordance with contractual arrangements and to mitigate capitation leakage.
• Ensure network adequacy in accordance with regulatory time and distance requirements.
• Support new onboarding activities for managed clients, new market expansions and new program rollouts.
• Load Contracts and Practitioners to contracting database application.
• Support other internal business units in resolving claims, authorizations, and eligibility issues.
• Support credentialing process by collecting documents for new and recredentialing applications
• Coordinate and perform tasks to meet all regulatory requirements and execute Prospect's and health plan's policies and procedures.
• Research and resolve provider issues and disputes in accordance to contractual arrangements.

Required Education/Experience

• 5 years managed care physician contracting negotiations

Preferred Education/Experience

• Four year college degree or higher or equivalent experience
• Financial review and contract performance
• Capitation compensation negotiations and implementation

"Location-Based Pay Adjustment"