Job ID: 95710 Date posted: May 14, 2019
- Sharp HealthPlan
- Business Operations Jobs
- Day Job
This position is responsible to identify, negotiate and manage health plan service contracts as well as vendor service agreements. The Contracts Specialist serves as the primary source of contract interpretation and enforcement, as needed, with assigned providers and works closely with all departments within the health plan.
Contracting functions within Finance Department and works closely with claims and the financial analysts when evaluating contract performance and rate negotiations.
Here's what Sharp Health Plan has to offer you:
Sharp Health Plan is the largest, locally-based commercial health plan in San Diego. We are a not-for-profit organization serving the needs of San Diegans since 1992. As a subsidiary of Sharp HealthCare, San Diego’s largest provider of health care services, we not only serve the people of San Diego, we are the people of San Diego.
Through our unique integration with Sharp HealthCare, we connect our members to an award-winning network of hospitals, medical groups and physicians. We offer health insurance options for individuals, families, groups and businesses that combine affordability, choice, high-quality health care and personal service.
Sharp Health Plan is the highest member-rated Health Plan among reporting California Health Plans.* We're also accredited by the National Committee for Quality Assurance (NCQA) with a status of Commendable which is awarded to organizations with well-established programs for service and clinical quality. We continually strive to improve the quality of our services and benefits, and seek innovative solutions to today’s complex health care issues. From helping you find the right health plan to the right doctor to being a great place to work, we’re here for you!
If you like the sound of what it means to be a Sharp Health Plan team member, and you meet the qualifications above, please submit your resume along with a brief explanation about why you would be a good fit for this position. We look forward to hearing from you.
*The source for this data is Quality Compass® 2016 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass® 2016 includes certain CAHPS® data.
This position is located in Kearny Mesa, San Diego County.
8-hour shift: 8:00 am - 5:00 pm, occasional weekend hours for special projects.
Required Skills and Qualifications
- Two to three years of progressive managed care industry contracting experience.
- An understanding of health services and delivery models, including hospital, physician and ancillary services.
- Knowledge of health care economics including various managed care reimbursement methodologies.
- Ability to analyze and interpret data; and prepare summary reports and finding.
- Working knowledge of the contemporary legal environment surrounding managed care contracting.
- Demonstrated ability to successfully negotiate provider contracts which address SHP’s interests under circumstances involved.
- Organization, analytical and problem solving abilities.
- Ability to create, modify and review contract documents during negotiations and for regulatory updates and new programs.
- Attention to detail and strong organizational skills with the ability to track documents from inception to final execution and loading into contracts database.
- Excellent written and verbal communication skills.
- Must be competent with Microsoft office, Word, Excel. Familiarity with Access Database
Preferred Skills and Qualifications
- Bachelor of Science in Business, Finance, Accounting, or Health Care Management
Additional physical requirements may be discussed at interview.
Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.
“After nearly 10 years of working here, it's still one of the hardest jobs I've ever loved. If you find a niche here, you'll be working with some of the smartest in the industry. This is where they'll respect you for thinking outside the box and kindness matters. They expect consistency and hard work, but pay you well to do it.”