You Make Us Grow. You Make Us Sharp.

Hours:

Shift Start Time:

Variable

Shift End Time:

Variable

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$64.350 - $83.040 - $101.720

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

Please Note: As part of our recruitment process, you may receive communication from Dawn, our virtual recruiting assistant. Dawn helps coordinate scheduling for screening calls and interviews to ensure a smooth and timely experience. Rest assured, all candidate evaluations and hiring decisions are made by our recruitment and hiring teams.

What You Will Do
Manage all Sharp Health Plan facility and ancillary contracts and coordinate negotiations to minimize financial risk and legal issues, while communicating contractual terms to ensure smooth administration. Multiple products and service lines, including but not limited to, HMO, PPO, POS, Individual, Medicare Supplement, ASO, Self-funded, risk adjusted contracts, dental, and government contracts with CalPers and the Exchange. Contract types to include capitation, fee for service, per diem, medical service agreements, service agreements, P4P, and other risk adjusted agreements as developed in conjunction with health care reform. Ensures effective management of SHP contracting to include network assessment and cost control. Ensures fair and reasonable rates of reimbursement within appropriate terms and conditions. Ensures accurate completion of contracts to include language review, appropriate signatures, etc.

Provide plan wide strategy and support through contract analysis, consultation in new program development, and assist in contract reimbursement modeling for the annual budgeting process, and development and management of Sharp Health Plan projects as a result of legislation. Responsible for operational support system to respond to contract informational needs and monitor facility and physician issues regarding contracting priorities. Provide operational support to internal and external customers.
Participates as part of and in support of the overall Sharp Health Plan management team that works to ensures success in reaching Sharp Health Plan goals and objectives.

Required Qualifications

• 3 Years experience in health care at a position in contracting.

Preferred Qualifications

• Master's Degree
• General hospital, medical or other clinical experience.

Other Qualification Requirements

• Bachelor degree in Accounting, Finance, Business Administration or Health Care Administration or similar equivalent health care experience is required.

Essential Functions

• Contract Management
  Responsible for all professional, facility, ancillary, medical group contracts, employer and broker contracts, service agreements, Letters of Agreement and any other contracts (as determined by CEO and CFO) to include analysis, negotiation, etc. Responsible for the updates and maintenance of the SHP contracts database.
  Develops and maintains mutually beneficial working relationships with providers. Responds to inquiries from new, potential vendors in support of the Sharp Health Plan mission, values and philosophy.
  Ensures ongoing analysis of provider contracts changing plans as necessary based upon the outcome of those analyses. Consistently strives to improve contract performance.
  Demonstrates ability to respond to requests and independently provides key information to the executive team, Director of Medical Economics & Contracting or SHP departments regarding all assigned contracts. Insure timely response to contractual issues and contract compliance problems. Responsible to notify contracted providers of any contract or regulatory changes that may significantly impact their practices.
• Contract Analysis
  As directed, provides insight and analysis on contractual requirements and obligations for new product lines pursued by Sharp Health Plan, including but not limited to PPO, POS, Individual, Medicare Supplement, ASO, Self-funded, risk adjusted contracts, dental, and government contracts with CalPers and the Exchange.
  Works in conjunction with SHP staff to design and implement contract reimbursement modeling and analysis used in contract renegotiation and to ensure correct reimbursements.
  Analyze paid claims or encounter data to monitor vendors, contractors and sub-contractor performance including any relevant benchmarking. Provides analysis and develops recommendations to add, modify or terminate existing agreements.
  Develops analysis and review processes with appropriate benchmarks to assess provider adequacy and cost control to ensure the effective management and performance of the various SHP networks and products.
• Contract Negotiation
  Evaluate contract language and provide financial and statistical analysis to ensure fair and reasonable rates of reimbursement within appropriate terms and conditions.
  Based on analysis, develop negotiation strategies that minimize Sharp Health Plan’s financial risk and legal issues. Negotiates contracts in accordance with Sharp Health Plan’s desired reimbursement goals and identified benchmarks.
  Ensures accurate completion of all assigned contracts to include language review, budget approval, appropriate signatures, system setup in accordance with contractual terms and update of the SHP contracts database.
• System Integration
  Develop and maintain communication links throughout the health plan to identify payor issues and the development of action items for resolution. Communicate current contract information, address contract issues and work with management to fully understand implications of decisions.
  Works with appropriate staff to ensure appropriate systems are accurate for claim pricing and claims payment.
• Management, Training and Support
  Provides direct leadership, project, and analysis support, to the staff within the SHP Contracts department to assist in cross-functional development of staff. Oversees all contracts functions at Sharp Health Plan, including the management of staff, recruiting, hiring, training, mentoring, reviewing, and disciplining of staff as appropriate.
• Provides Internal and External Customer Service
  Maintains plan wide service orientation through consistent assessment of needs and timely response to requests. Effectively participates with and/or provides support to customers in the design, review, development and implementation of new programs.
  Demonstrate ability to advise and educate SHP employees on regulations and contract terms. Provides prompt, accurate and excellent services to internal and external customers.
  Develops solid professional working relationships with various internal departments and units and, as required, vendors, providers, employers, brokers and/or other customers.
• Dependability and Teamwork
  Completes assigned duties in a safe, cost-effective manner. Uses and plans personal leave time according to departmental guidelines. Accepts interpersonal differences and promotes cooperation with fellow employees. Maintains confidentiality of information to which he/she has access.
• Quality and Process Improvement
  Looks for opportunities to improve operational and financial performance, including cost savings, revenue enhancement, workflow effectiveness, etc. and evaluates the success of such projects. Ensures departmental efficiency and effectiveness through continuous quality improvement initiatives.

Knowledge, Skills, and Abilities

• This position requires, at a minimum, excellent skills in verbal and written communication; excellent knowledge of Managed Care, Health Care Finance, Manage Care Contracts; experience in PC computer utilization for work processing and spreadsheet analysis. Additionally, the ability to develop and maintain good working relationships with payor executives is critical and prior experience is required.
• Demonstrated analytical ability in a health related or contract negotiation environment.
• Ability to meet frequent deadlines and tight schedules.
• Strong analytical skills and demonstrates the ability to aggregate large quantities of data in a short time frame. Demonstrates the ability to make strategic and tactical recommendations. Proven track record for successful implementation and oversight of tactical recommendations achieving measurable results. Demonstrates quality and process improvement philosophy to improve operational effectiveness and efficiency. Excellent time management skills. Ability to work in a cohesive service orientation and focus. Possesses interpersonal skills to develop and maintain relationships with the Board of Directors, SHC counterparts, representatives of financial institutions, and other outside parties that contribute to the success of Sharp Health Plan.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class

Master's Degree