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.
PI
Keywords: Pace of Southwest Michigan, South Bend , Contract Specialist, Other , Saint Joseph, Indiana
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