Payer Strategy Contract Specialist

Overview:

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

This is a remote position and strongly prefer someone in Utah or Utah Payer work experience.

Works closely with the Contract Manager and other Payer Strategy Relationship leadership, to support the negotiation of terms and conditions for Managed Care payer contracts for facility, professional, and ancillary entities. The primary focus of this role is contracting support (specifically credentialing, payer/ provider relations and payer operations).  

Essential Key Job Responsibilities

1. Supports the Contract Manager/Director in the maintenance of contracts and rate sheets to ensure accuracy, completeness and in compliance with CommonSpirit Health standards and guidelines.
2. Responsible for facility credentialing and recredentialing of Utah/CommonSpirit entities. Ensures all credentialing documents are up to date.
3. Maintains complete and up to date inventory of all CSH hospitals/specialty hospitals to include demographic information, license, NPI, Tax ID information, etc.
4. Responsible for ensuring Payers have accurate provider rosters on file and notifying payers of changes to contracts that require amendments. 
5. Responsible for mass payer communications and coverage queries. (Example CDM notifications)
6. 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.
7. Work with internal and external contacts to ensure that payments abide by the terms of the agreement. Role is responsible for identifying root cause of contractual claims issues.
8. 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.
9. Assists in communicating and operationalizing contract terms, amendments, and policy terms.
10. Maintains National Payer knowledge base to include financial statements/reports, news articles and other information.
11. Adheres to all established contracting guidelines. Contracting accountability for negotiation support include hospital, physician, and ancillary services.
12. May participate in negotiations as appropriate.

• Bachelor’s degree or equivalent education and experience
• Minimum of three (3) years payer relations experience
• Hospital system or physician office experience strongly preferred

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