An Insight Global client is looking for a contract specialist to work in Columbus but also open to remote candidates. This person will be responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. 50% of their day will consist of outbound calls and the other 50% will be following up with internal customers.
This person will be responsible for negotiating assigned contracts and letters of agreements with hospitals, physician groups and ancillary providers that result in high quality, cost effective and marketable providers.
Maintains tracking system and publish reports according to departmental procedures.
Initiates, negotiates, generates and tracks provider Letters of Agreement, contracts and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments.
Assists Manager and/or Director in the negotiation of medical group/IPA and hospital contracting.
Identified as contract system lead by developing and maintaining provider contracts in EMPTORIS contract management software.
Assists Manager and/or Director in the completion of Block Transfer Filings
Facilitates and resolves claim and configuration issues with impacted departments.
Participates in other contracting related special projects as directed.
Supports network development throughout state to including researching, recruiting and negotiating with providers.
Participates in the evaluation of provider network and implementation of strategic plans to meet Molina's network adequacy standards.
Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers.
Assists in analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided, and other information needed to complete the contract profile.
Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes.
Travels regularly throughout designated regions to meet targeted needs.
Communicates proactively with other departments in order to ensure effective and efficient business results.
Trains and monitors newly hired Contract Specialist(s).
Participates in other contracting related special projects as directed.
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
HR@insightglobal.com.
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https://insightglobal.com/workforce-privacy-policy/ .
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.