Sutter Health Contract Operations Specialist in Sacramento, California
The Contract Operations Specialist – serves as a liaison between the affiliated medical foundations/groups, hospitals or ancillary within Sutter Health to ensure contract compliance and operational functions related to managed care agreements, and serves as liaison with MSOs for same clients. The Contract Operations Specialist is responsible for operational coordination across Payers for issues such as ICD-10, consolidation of Sutter Health operating units, Payer notifications, etc. and educates all Affiliates and Payers regarding contract compliance issues and terms. Participates in the drafting of systemwide template contract boilerplate language and assists in the development of changes to Payer contracts such as the Division of Financial Responsibility (DOFR) and/or delegation exhibits. Supports the resolution of contract disputes between Affiliates and Payers including claims or other administrative issues and is responsible for various projects, as assigned.
Bachelor Degree or equivalent combination of education and experience is required for this role.
Experience in healthcare or health plan environment with progressively responsible positions; a minimum of five years experience in managed care operations for hospitals, medical groups and/or Payers. Demonstrated experience in enforcing contract compliance, dispute resolution, project management, regulatory requirements and medical claims.
Strong knowledge of medical billing and payment structures used by healthcare providers and Payers; as well as contract terms and language, including but not limited to capitation terms and DOFRs. An in-depth understanding of all regulatory requirements as it relates to provider/payer operations including but not limited to the Affordable Care Act, Knox-Keene Act, Department of Managed Health Care rules, CMS rules, HIPAA/HITECH and ERISA. Skills in database management and word processing are also required.
The incumbent must possess the ability to enlist cooperation and build consensus through effective communication skills, both written and oral, to carryout initiatives in environments with varying opinions and objectives. Demonstrated ability to engage in positive, powerful persuasion with individuals or groups with diverse opinions and/or agendas; ability to influence and facilitate others, as needed, to ensure the effective management of multiple complex, multi-faceted projects is required. Must have the ability to maintain a high level of energy and creativity as well as the ability to work independently, prioritize multiple objectives in a rapidly changing environment and deliver quality outcomes. Must have the ability to escalate issues to supervisor or leads, when appropriate. Must have the skills to develop and create reports or other presentation materials for use by Contract Managers, Directors and/or Vice Presidents.
Primary Location: California, Greater Sacramento Area, Sacramento
Organization: Sutter Health System Office
Employee Status: Regular
Position Status: Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: Other
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.