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Years of Experience
ProfileContracts Specialist The candidate: Assists in supporting Department and is accountable for all activities within assigned scope of authority. The specialist's assigned scope of authority may focus on one or more lines of business (specialty network, fitness, and/or wellness and prevention). Prepares and manages standard form contracts, agreements and amendments including, but not limited to the following (if applicable to the assigned lines of business): Employer group agreements such as group contracts, group subscriber agreements and administrative/network agreements etc. Health Plan Agreements such as capitation and compensation service agreements, administrative/network agreements, delegation agreements, wellness and prevention agreements, etc. Provider, practitioner, or fitness facility agreements. New Products and other Agreements or Amendments as assigned. Acquires and maintains subject matter expertise with assigned clients in a constantly evolving contracts environment. With supervision, prepares revisions of various standard form contracts, agreements and amendments, including but not limited to, group agreements, health plan agreements, and member materials, as assigned by Director. With supervision, collaborates with the applicable line of business leadership team, committees (CCC and KPT), and other departments to develop negotiation parameters and strategies for use in the development of contracts to support existing and new products agreements and amendments. Modifies standard form agreements with revised standard options. Independently prepares non-standard modifications to reflect negotiated changes, within parameters approved by Director. With supervision, conducts agreement and amendment negotiations with clients, including conference calls. Works with Regulatory Compliance Department to: a) ensure regulatory requirements provided by the Regulatory Compliance Department are included in agreements executed in certain states; and b) provide contract information and support needed for compliance activities. With supervision, negotiates contracts, agreements and amendments with external clients as assigned by Director and within parameters approved by Director. Informs Director of urgent issues. Maintains Contracts and Agreements Library of executed agreements. Supports administrative functions of Department. Provides Director with periodic contract status updates regarding client assignments. Manages client timeframe expectations and escalates concerns regarding ability to meet client timeframe expectations. Assists with training of new employees. Interacts positively with other departments and external contacts as needed. Represents ASH in an ethical, professional, and positive manner. Maintains all information and material received from employer, clients, and legal counsel during employment on a strictly confidential basis. The sharing of any information is strictly forbidden under any circumstances with any non-employee of the company. Maintains computer and system skills necessary to perform job functions. Assists with process management including but not limited to tracking and filing. Photocopies, files, and faxes as needed to support job responsibilities. Should have Bachelor's degree in English, History, Political Science, Paralegal certificate or equivalent experience. Master's degree in Health Care Administration, Legal degree preferred. Must have 2+ years' experience in contract development and an emphasis in contract management. Internal ASH experience and in depth understanding of ASH systems, policies and procedures preferred. Experience with health insurance contracts, managed health care, and/or working with health plans and employer groups preferred. Knowledge of Health Care Regulations preferred. Should have excellent research skills.
American Specialty Health, Inc. (ASH Companies)
10221 Wateridge Circle
San Diego, CA 92101-6002