Contract Operations Specialist

We are seeking a highly motivated and experienced managed healthcare Contract Operations Specialist to join our team in Northern California. Reporting to the Manager of Contract Policy and Operations, this role requires a skilled professional with in-depth knowledge of managed healthcare contract administration between IPAs, providers and health plans. The individual will join a team managing the end-to-end process of implementing health care contracts for commercial, Medi-Cal and Medicare Advantage HMO business, ensuring all contractual obligations are operationalized.

Key Responsibilities :

• Develop and sustain mutually beneficial relationships with health plan and provider representatives.
• Implement new and amended health care contracts. Ensure smooth onboarding and transition of contracts from initiation to full operational status.
• Work closely with internal teams including Legal, Compliance, Operations, IT, and Physician and Member Services to meet and maintain contractual requirements.
• Maintain commercial, Medicare and Medi-Cal HMO guidelines and Practice Operations Manual through review and content editing. Work with subject matter experts to clarify and address information gaps and discrepancies.
• Assist in developing training materials and provide ongoing education for internal staff regarding contract specifications, processes, and best practices for managing contracts.
• Negotiate terms of managed care contracts with health care providers.
• Adhere to contract documentation processes using Salesforce and applicable systems.
• Identify potential risks and roadblocks in the implementation process. Work proactively to resolve issues and ensure that the project remains on track.
• Utilize advanced features of database and spreadsheet software to aid in project work, including ad hoc reporting.
• Other duties as assigned.

Education :

Experience :

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