Contract Operations and Implementation Specialist - 25-90

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At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

Reporting to the Manager, Contract Policy and Operations, the Contract Operations and Implementation Specialist (COIS) is responsible for supporting the company in the implementation of provider and health plan contracts to ensure accurate interpretation and operationalization of contract terms. The COIS coordinates activities and information exchange between the Contracting Department, internal operations/business units, information services, and contracted entities. The COIS ensures that contracts, including benefits, products and programs, are implemented correctly and in a timely manner across the organization.

ESSENTIAL RESPONSIBILITIES:

• Support and lead multi-departmental work groups to operationalize provisions of new contracts and amendments. Identify and resolve issues related to new and existing contract requirements. Collaborate with and guide appropriate departments to ensure that required policies and procedures are shared, understood and implemented and monitored in a timely manner. Provide descriptions of applicable health plan products or programs, and identify any unique operational requirements or obligations (e.g., narrow networks, performance programs).
• Support and facilitate work groups to provide oversight of existing contracts. On an ongoing basis, monitor, and ensure accurate and consistent interpretation of existing products and programs, and facilitate correction plans as necessary.
• Act as key liaison from the Contracting Department for health plan issues and questions for all internal departments.
• Remain current in benefits, product design, and program changes and provide guidance to internal clients.
• Establish and maintain strong relationships with key PriMed departments and facilitate the translation of business needs to technical staff.
• Act as liaison from the Contracting Department for Joint Operations Committee (JOC) meetings, working with applicable Hill Physicians departments to drive agendas and facilitate meetings. Maintain record of unresolved health plan issues, and coordinate resolution of such issues.
• Monitor all health plan communications sent to PriMed and/or Hill Physicians as well as to individual physician practices (when known), and distribute such communications internally, as appropriate, to ensure all stakeholders are informed of applicable information. Work with appropriate departments to modify existing policies to comply with health plans. When necessary, initiate and coordinate meetings with applicable departments to ensure policy and operational compliance.
• Monitor legislative and regulatory requirements that relate to operations, and recommend and coordinate implementation strategies to comply with such requirements, as communicated by health plans, regulatory agencies or PriMed / Hill Physicians. Communicate to applicable departments any legislative changes impacting the operational obligations of PriMed / Hill Physicians with its health plans. Assist the Contracting Department, as necessary, to implement such changes in contracts.
• Work closely with appropriate departments to develop training materials to ensure that all necessary staff are educated and trained to consistently administer health plan and provider contracts.
  
  

NON-ESSENTIAL RESPONSIBILITIES:

This position will also have additional departmental responsibilities which include but are not limited to assisting with facility and/or ancillary contracting duties, contributing to the development and implementation of a centralized provider data content system, and other departmental duties as required.

SKILLS AND EXPERIENCE REQUIRED:

• Minimum years of experience required – 3-5 years of managed care industry experience.
• Minimum level of education required – Bachelor’s degree required
• Licenses and certifications required – None
• Exceptional written and verbal communication skills, including public speaking and facilitation skills. Strong desktop application skills including Word, Excel, and PowerPoint, database management skills a plus.
• Ability to identify and define work process issues and work collaboratively to find solutions.
• Strong project management skills.
• Effective at working independently and in partnership with key internal stakeholders. Able to develop constructive and credible relationships with external business partners.
• Must be able to successfully and simultaneously manage multiple projects and deadlines.
  
  
  

Additional Information:

Salary: $85,000 - $110,000 Annual

Hill Physicians is an Equal Opportunity Employer