Managed Care Contracts Specialist

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

This is a remote position with a strong preference for a candidate to reside in the Eastern or Central time zones. 

Works closely with the Contract Manager and other PSR leadership, to support the negotiation of terms and conditions for Managed Care payer contracts for facility, professional, and ancillary entities. Primary focus of contracting and negotiation support is to ensure the terms and conditions of the payer contract adhere to the CommonSpirit Health Standards and Guidelines, represent industry best practices for Fee for Service and value-based arrangements, and align with operational objectives.

• Supports the review of contract proposals, language and rate sheets to ensure accuracy, completeness and in compliance with CommonSpirit Health standards and guidelines.
• Reviews and redlines contract language and makes recommended improvements to contract manager or director. 
• Understands Payer Policies and administrative guides and how it might impact the contract at hand. 
• Recommends corrections, changes and any language opportunities in documents to leadership
• Assists Payer Strategy Relations leadership with developing and updating project plan documents, meeting minutes and action item follow up related to National Payers renewals and planning.
• Ensures all amendments, letters of agreement (LOA), memorandum of understanding (MOU) and other contract documents are signed by the appropriate parties and provide the fully executed contract documents to the Contract Administration team.
• Ensures contract documents include rate escalators and obtain updated rate tables fee schedules and all contracting materials are stored according to PSR and/or Legal Policies, and ensures information is made available to or disseminated to key stakeholders of the negotiation process.
• Coordinates with other Payer Strategy Relations team members to facilitate credentialing and re-credentialing of CSH entities.

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Required

• Highschool diploma
• Three (3) years support of contract negotiation experience in a healthcare related field
• Payer or Provider experience