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PHP - PROVIDER CONTRACT ADMINISTRATOR

Company: Sparrow
Location: Lansing
Posted on: May 15, 2020

Job Description:

Job Opportunity Job ID:--20082 Positions Location: Lansing, MI -- Job Description General Purpose of Job:---- The Description: Positions Location: Lansing, MI -- Job Description General Purpose of Job:---- The Provider Contract Administrator is responsible for initiating, negotiating and coordinating contracting and recruiting efforts related to the development and maintenance of a provider network for each product. Including interpretation of the financial analysis and negotiated reimbursement provisions. Responsible for the oversight of provider compensation submissions and audits to ensure provider agreements are configured according to the intent of the negotiated provider contract. In addition, the Provider Contract Administrator will assist in the loading, maintenance and auditing of provider and facility reimbursement provisions in the claims adjudication system to ensure providers receive correct reimbursement and financial allowance for services rendered. Responsible for assisting the Sr. Contract Administrator in the drafting and dissemination of provider and administrative agreements, amendments, and other related contracting documentation. Essential Duties: This job description is intended to cover the minimum essential duties assigned on a regular basis.-- Caregivers may be asked to perform additional duties as assigned by their leader.-- Leadership has the right to alter or modify the duties of the position.-- Coordination and execution of recruitment and contracting for all products with ancillaries and physician organizations. Interpretation of data in analytic tools and software for the analysis of hospitals, ancillaries, and physicians provider utilization as needed for the assessment of financial impact of contract arrangements. Negotiates favorable agreements with providers and administrators who are interested in participating within the PHP network of providers. Negotiation and execution of Single Payor Agreements (SPAs). Identify and contract with key providers for expansion of PHP service area. Collaborates with the Pricing Department for the implementation of provider agreements to ensure accurate reimbursement in accordance with the intent of the agreement. Queries and performs functions using the SAS database and/or the annual 1099 reporting. Ensures provider data and contract terms are accurate within FACETs. Develops and distributes correspondence to communicate new or revise provider agreement changes to internal stakeholders for review. Solves provider contracting related problems and disputes. Job Requirements General Requirements Demonstrates knowledge and maintains and respects patient right to privacy by following the HIPAA Privacy and Security policies and procedures. Adheres to ICARE values and standards of behavior (Innovation, Compassion, Accountability, Respect, Excellence). Role model behaviors that value the diversity of our caregivers, patients and customers and supports creating an environment that is inclusive, welcoming and respectful. Communicates with patients, families and customers using AIDET (Acknowledge, Introduce, Duration, Explanation, Thank). Works in a safe manner and promptly reports any hazards identified in the work environment or related to assigned responsibilities. Adheres to policies and procedures designed to avoid, prevent and reduce the spread of communicable diseases. Work Experience Minimum of 2 years of managed care with Provider Contracting, Network Management or Provider Relations experience Education Bachelors degree or Associates degree and 3 years of managed care with Provider Contracting, Network Management or Provider Relations experience Specialized Knowledge and Skills Proven planning, preparation and presenting skills, with established knowledge of reimbursement Demonstrated ability to manage multiple projects and meet deadlines Provider problem solving skills Demonstrates ability to use a keyboard as may be required to perform the essential duties of the job. Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and value-based reimbursement methodology. Preferred Comprehensive knowledge of Managed Care policies, processes and procedures. Preferred. This position will serve the Southeastern Metro-Detroit market and will require travel. Sparrow Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status. Job Family Management/Professional Requirements: Shift Days Degree Type / Education Level Bachelor's Status Full-time Facility Physicians Health Plan Experience Level Under 4 Years

Keywords: Sparrow, Lansing , PHP - PROVIDER CONTRACT ADMINISTRATOR, IT / Software / Systems , Lansing, Michigan

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