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Contracts Admin

On Lok San Jose, CA
  • Posted: 27 days ago
  • Other

On Lok Lifeways

We are a non-profit committed to our participants. On Lok Lifeways PACE long term senior care is provided by On Lok Senior Health Services, a 501(c)(3) non-profit

Dedicated to The Care of Elders:

On Lok, Inc. is a not-for-profit organization founded in the early 1970s by a group of citizens concerned about the plight of elders and the lack of long term options in the community. On Lok, Inc. serves as the administrative arm of a group of five affiliated non-profit organizations. Its functions include research and development, human resources, fundraising and management information systems.

We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare.

Join our team of leaders to begin a rewarding career!

POSITION SUMMARY: Under the direction and supervision of the Regional Provider Network Manager, the Contract
Administrator negotiates and implements contracts with outside healthcare providers
providing PACE services to On Lok Participants.


DUTIES / RESPONSIBILITIES:


1. Effectively negotiate and implement healthcare contracts with physicians/other professionals, nursing homes and
ancillary (including ambulance, DME, home health/hospice, imaging, lab, RCFE) providers that meet
reimbursement goals within approved authority limits.
2. Develop and maintain working relationships with outside provider community for both existing provider network
and potential new network providers.

3. Collaborate with Enrollment team members to establish consistent and strong relstionship with provider offices and facilities tohelp achieve membership growth and retention.
4. Effectively negotiate and implement individual letter of agreements within approved authority limits.
5. Acts as primary point of contact for contract interpretation, and for contract dispute related to claims inquiry.
6. Maintains working knowledge of PACE, DHCS and Knox Keene regulations pertaining to provider contracts.
7. Maintains working knowledge of reimbursement methodologies related to Medicare and Medi-Cal such as
Resource-Based Relative Value Scale (RBRVS), Prospective Payment System (PPS), Resource Utiliziation Group (RUGs), Patient Dirven Payment Model (PDPM), and lab/ambulance.
8. Provides input and participates in strategic planning efforts.
9. Maintain contract files both soft and hard copy format.
910. All other reasonably related duties as assigned.

QUALIFICATIONS (knowledge, skills, abilities):
1. Minimum BA in business, healthcare management or other relevant discipline preferred.
2. Three to five years' experience in a managed care field working with payors/providers in contract negotiations.
3. Detail oriented accuracy.
4. Ability to establish negotiating strategies that leads to successfully implementing contracts.
5. Ability to establish priorities and goals including workflow/project management and organization skills.
6. Strong communication skills, both oral and written.
7. Familiarity with Microsoft Office including Excel, Outlook, and Word.
8. Ability to learn proprietary database(s) such as electronic medical record and claims payment system.
9. Occasional travel to provider locations in Fremont and San Jose area.

On Lok's Employee Benefits include (eligible for any position for 20 hr/wk or more):

  • Medical, Dental, and Vision coverage
  • Retirement Savings Plan 403(b) and Term Life/AD&D Insurance
  • Flexible Spending Account, Commuter Checks, MLA scholarships, Employee Assistance Program (EAP)
  • Pet Insurance and additional discounts
  • Holidays (10 per year), vacation time, sick leave, and long-term disability insurance


Job Posted by ApplicantPro

On Lok

Address

San Jose, CA
95116 USA

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