Director Contract Administration
Company: Community Health Group
Location: Chula Vista
Posted on: January 12, 2021
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Job Description:
POSITION SUMMARY Provides exemplary contracting services to
CHG's providers by managing the Contracting Department's System
Set-Up (configuration) Team and Network Committee team functions
and resources; leading and managing the work efforts of the
department's staff; coordinating contractual activities with other
departments; maintaining service levels in compliance to federal,
state law.COMPLIANCE WITH REGULATIONS:Works closely with all
departments necessary to ensure that the processes, programs and
services are accomplished in a timely and efficient manner in
accordance with CHG policies and procedures and in compliance with
applicable state and federal regulations including, CMS and/or
Medicare Part C and Coordinated Care Initiative.RESPONSIBILITIES *
Develops and maintains contract templates for CHG contracting
providers - updated annually. * Communicates with provider staff
and resolves issues by relaying CHG's philosophy of member
management, commitment to quality care and cooperative network
development; meeting with various CHG departments/staff to review
direct contract issues; developing solutions to problems; reviewing
reimbursement provisions, utilization data, cost reports and
enrollment reports; assisting with the dissemination of practice
profiling information.* Plans department operations by promoting
teamwork and motivating staff to accomplish tasks; assuring
availability of developmental and training opportunities for team
members; providing guidance to team members in all related
activities, including production and operations; managing
administrative and personnel issues; selecting, training and
orienting staff; providing education for staff; monitoring and
supervising work, evaluating performance; recommending personnel
actions; developing and maintaining job descriptions for staff
members.* Communicates with the Director of Claims Administration,
Director of Utilization Management, Senior Director of Health Care
Services and Senior Director of Operations to review contracts
prior to contract issuance to ensure optimum claims adjudication
compatibility and referrals/authorizations compatibility.* Delivers
high quality contracting services by planning, implementing, and
managing Contracting Department programs designed to enhance the
timely production of contracts; negotiating financial contracts
with CHG's providers.* Ensures network adequacy in compliance with
regulatory requirements.Draft and review contracts and, as needed,
Letters of Agreement, to protect the interests of CHG and its
members. Make recommendations to the Chief Operating Officer to
meet the needs of CHG clinical team.* Ensure the delivery of timely
and accurate government reports as necessary.* Supervise the
Contracting Department Contract Development Manager and
Administrative Assistant.* Keeps management informed by
communicating and interpreting changes in guidelines, policies,
procedures and regulatory requirements; keeping administration
informed of department activities, needs and problems; maintaining
close liaison with other departments to assure coordination,
standardization and continuity; keeping abreast of appropriate
regulatory agency requirements; preparing an annual report of the
activities of the Contracting Department.* Maintains professional
and Technical knowledge by attending educational workshops;
reviewing professional publications; establishing and maintaining
personal networks; participating in professional healthcare related
activities.* Maintains product and company reputation and
contributes to the team effort by conveying professional image and
accomplishing related tasks; participating on committees and in
meetings; performing other duties as assigned or
requested.Education:* Bachelor's Degree in Business Administration
or Health Care Administration.* Master's Degree in Healthcare
Administration, Business Administration or related field
required.Experience/Skills:* 5 years of contracting experience in a
managed care environment, including contract development,
negotiation, and administration. 3 years supervisory experience.*
Strong knowledge and understanding of federal, state and local
healthcare regulations. Familiarity with Medicaid, CCS.
CMS/Medicare, DMHC and DHCS.* Excellent analytical skills; ability
to communicate effectively, both verbally and in writing; ability
to establish and/or build relationships with providers and
regulatory agencies; strong management and leadership
skills.Physical Requirements:* May require prolonged sitting.*
Frequent traveling, including driving within County of San Diego.*
May be required to work evenings and
weekends.QualificationsEducation: * Bachelor's Degree in Business
Administration or Health Care Administration.* Master's Degree in
Healthcare Administration, Business Administration or related field
required.Experience/Skills:* 5 years of contracting experience in a
managed care environment, including contract development,
negotiation, and administration. 3 years supervisory experience.*
Strong knowledge and understanding of federal, state and local
healthcare regulations. Familiarity with Medicaid, CCS.
CMS/Medicare, DMHC and DHCS.* Excellent analytical skills; ability
to communicate effectively, both verbally and in writing; ability
to establish and/or build relationships with providers and
regulatory agencies; strong management and leadership
skills.Physical Requirements:* May require prolonged sitting.*
Frequent traveling, including driving within County of San Diego.*
May be required to work evenings and weekends.
Keywords: Community Health Group, Chula Vista , Director Contract Administration, Executive , Chula Vista, California
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