PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Whittier Hospital, PIH Health Downey Hospital and PIH Health Good Samaritan Hospital, 27 outpatient medical locations, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, women’s health, urgent care and emergency services. The organization is recognized by Watson Health as one of the nation’s Top Hospitals, and College of Healthcare Information Management Executives (CHIME) as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. PIH Health is certified as a Great Place to Work TM. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
Under the supervision of the Sr. Manager, Network Administration, the Contract Specialist II will be responsible to conduct all initial contract evaluations, negotiation/renegotiations, implementation and maintenance of provider agreements, and identifying/resolving contract related payer/provider issues in a timely manner. The Contract Specialist II will be a member of the PIH Health Contracting team and will conduct day to day operational activities along with maintaining all contract and correspondence files, performing provider health plan submissions, and ensuring accuracy of provider data in the PIH Health operating system. This position will develop needed Ad-Hoc letters of agreements (LOA) required to support Claims & Utilization Management Departments. Position has responsibility for dashboards, spreadsheets and analyzing each Specialty and Ancillary contract to ensure the contracts in place are performing efficiently and producing financially sound results to supplement and enhance the entire PIH Health network.
Excellent customer service skills, analytical and problem solving skills are a must, as well as demonstrated ability to effectively produce assignments within required time frames.
Requires literacy in PC applications such as Word and Excel applications.
Able to perform multiple tasks and apply solid organization skills.
Requires strong verbal and written communication skills.
Must be able to demonstrate sound decision making and prioritization skills.
Must be a skilled negotiator with strong problem solving skills and adept at persuasion.
Must have familiarity with medical terminology.
Must be familiar with Medicare-based payment methodologies, standard coding and managed care terminology.
Must be familiar with Medi-Cal and all regulations.
Must have a good understanding of the claims process.
Must work independently and possess strong problem solving and analytical skills.
Must be proactive in presenting solution to complex provider issues.
Must be able to apply past knowledge to new situations.
Ability to do both internal and external research related to provider status and reimbursements in order to prepare for network development and contracting.
Must have five (5) or more years of work experience in a managed care environment with three (3) years or more of experience in provider contracting or provider relations.
Must be knowledgeable in various provider payment methodologies and basic payer/provider contract language.
Experience analyzing rates, utilization data & developing pricing models, intermediate to advance user of spreadsheet & database applications.
Well versed with provider and claims data elements.
Beyond the benefits that come with working for the area's leading community healthcare provider – one that also recognizes the need to ensure patient safety and comfort – you'll enjoy an extremely competitive compensation and benefits package. We are an equal opportunity employer and seek diversity in our workforce. EOE M/F/D/V