Provider Services Contracts Analyst

We have an opportunity to join the Alliance as the Provider Services Contracts Analyst within the Provider Services Contracts team.

ABOUT THE TEAM

The Provider Services Contracts team manages agreements with our providers. They ensure that providers are aware of their legal requirements and that the Alliance is meeting its contractual requirements for both the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC).

ABOUT THE JOB

The Provider Services Contracts Analyst will oversee the lifecycle of provider contracts, this role ensures compliance and conducts thorough analysis to evaluate solutions. Additionally, it collaborates with stakeholders, provides guidance on policy, and produces reports for external audits and regulatory purposes.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Provider Services Contracts Manager, this position:

• Processes and tracks routine provider contracts from creation through final execution and ensures legal and regulatory compliance
• Conducts research and analysis on contract terms and language to evaluate solutions and alternatives
• Collaborates with individual stakeholders to provide guidance on Alliance contracting policies and procedures
• Collects and synthesizes data to produce reports for external auditors and state agencies

THE IDEAL CANDIDATE

• Understanding of payment information and claims exposure is preferred 
• Experienced in filling contract requests and dispatching contracts especially with D-SNP programs for hospital rates
• Proficient in understanding the process from receiving contract requests through validating information through contract systems
• Capable of communicating rate and payment information to providers, explaining and translating financial terms for accurate and consistent system configuration
• Knowledge of how contracts are implemented within systems and the importance of translating contracts effectively, with claims exposure seen as beneficial
• Ability to analyze the impact of contractual amendments, considering timelines and contractual requirements with providers in project settings

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

• Knowledge of:
• Legal terminology and standard contracting agreement structure
• Legislative and regulatory directives
• The principles and practices of customer service
• The methods and techniques of research, analysis, and reporting
• Some knowledge of the methods, tools and techniques associated with contract development, review, implementation, and management
• Ability to:
  • Independently negotiate routine contract provisions within the scope of assigned authority
  • Exercise sound judgment and discretion and recognize issues requiring escalation to management
  • Understand, interpret, and apply contract language legislative and regulatory directives, policies, standards, and guidelines
  • Learn and apply Medi-Cal and Medicare specific regulations and processes to contract activities
  • Learn and apply the principles, practices and issues related to the Medicare Dual Special Needs Plan (D-SNP)
  • Demonstrate strong analytical and research skills, identify and troubleshoot issues, identify alternative solutions, and make recommendations for action
• Education and Experience:
  • Bachelor’s degree in Business, Legal Studies, Healthcare or a related field or possession of a Paralegal Certificate
  • A minimum of three years of experience in health services, managed care, contracting or government assistance programs which included experience supporting or performing contract negotiations (a Master’s degree may substitute for two years of the required experience; a J.D. degree may substitute for three years of the required experience); or an equivalent combination of education and experience may be qualifying.

OTHER DETAILS

• While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
• Our Alliance office locations have officially re-opened after the pandemic and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
• Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below. 

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).