Contract Specialist

Company: Pace of Southwest Michigan
Location: Saint Joseph
Posted on: August 3, 2022

Job Description:

Description: PACE of Southwest Michigan is seeking an experienced Contract Specialist to add to our TEAM!PACE (Program of All-Inclusive Care for the Elderly) is a unique healthcare solution for seniors who struggle with health issues that may jeopardize their independence. PACE is a wonderful alternative to nursing home care which enables participants to live safely at home. The Contract Specialist works under the guidance of the CFO to ensure compliance with Medicare and Medicaid rules and regulations with regards to health plan management reporting for PACE of Southwest Michigan. The contract specialist is responsible for managing all aspects of Pace contracts, including preparing, revising, negotiating, examining, and analyzing the documents. Also, coordinating the implementation, presentation, and servicing of all contracts for the entire organization.

• Coordinate the processing of all payer contracts and amendments. Coordinate all steps required in the development, review and processing of new contracts, contract renewals and contract amendments with payers.
• Coordinate all required steps for the execution of contracts and amendments and ensure completion or execution of finalized contracts and amendments within specified time frames or deadlines.
• Perform detailed review of the business terms in contracts and amendments received from payers, identify unacceptable terms, and recommend revised terms that meet the needs of PACE.
• Negotiate Single-Case agreements when necessary.
• Develops and maintain contracting decision making and tracking tools.
• Develops model contracts or contract language for use in proposing contract or amendments to payers.
• Establish reporting techniques that will identify areas of concern and prepare recommendations to address any issues.
• This position distributes this information throughout PACE in a timely fashion. Conduct pro-active communication, contract compliance, and educational sessions. Develop and maintain effective relationships with payers and internal customers
• Responsible for developing performance measurement tools to assess the financial success of PACE contracting process.
• Assist in creating custom financial reports and analysis, as needed.
• Participate in various quality improvement initiatives, as requested.
• Interacts with medical claims adjudication TPA, EMR vendor, CMS and other contracted agencies.
• Responsible to serve as backup for daily download of Gentran reports from CMS.
• Perform sourcing, liaising, and negotiating with new and existing supplies to improve business.
• Re-negotiate contracts with suppliers to produce better savings and further value for spend.
• Interact with external providers and vendors to establish and maintain strong relationships (including C-level executives, owners, mid-management, and front-line employees).
• Abides by all established PACE of Southwest Michigan policies.
• Perform other duties, as required. Requirements: Education: High School Diploma or equivalent required, Bachelor's degree preferred. Experience: Minimum 2 years' experience in business, contracting or other related experience. Preferred knowledge of CMS/HPMS and basic understanding of contract law, relationship development and negotiating skills.Number/Type of Employees Supervised: NoneLicensure, Registry, or Certification Required: N/ASpecial Training: Only acts within scope of practice. Meet a standardized set of orientation and/or individual competencies for the specific position description established by PACE of Southwest Michigan and approved by CMS before working independently.Immunizations: Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact.Specific Requirements and Considerations: May be subject to exposure and handling of infectious waste, diseases, conditions, or hazardous chemicals, etc., including potential exposure to TB, AIDS, and/or Hepatitis B.Ages of Patients Rendered Care: Adult, Geriatric
  • High level of autonomy is required for decision making.
  • Excellent attention to details.
  • Excellent organizational skills.
  • Excellent verbal and written communication skills.
  • Excellent Intrapersonal skills
  • Ability to effectively interact with diverse internal and external individuals (including C-level executives, owners, mid-management, and front-line employees)
  • Ability to work a flexible work schedule.
  • Able to utilize basic computer skills in the workplace.
  • Ability to work well under pressure.
  • Ability to effectively communicate and prioritize work
  • Ability to manage and clarify ambiguity
  • Excellent time management skills.
    
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Keywords: Pace of Southwest Michigan, South Bend , Contract Specialist, Other , Saint Joseph, Indiana