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Contract Specialist - Provider Relations in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 4/6/2019

Job Snapshot

Job Description

At Scripps Health, you will experience the pride, support and respect of an organization that has been repeatedly recognized as one of the nation’s Top 100 Places to Work.
You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you’re open to change, go ahead and unlock your potential.
The Provider Relations Contract Specialist is the internal and external liaison for the Provider Network Management Department.  In this role you will be maintaining positive working relationships with payors, affiliated and participating providers, including: plan medical groups (PMG’s), physicians, hospitals and/or ancillary providers.
The Provider Relations Contract Specialist is responsible for the daily administration and operation of the contractual provider relationships, overseeing accurate and current provider databases, developing and providing provider training, education, and communicating information to ensure regulatory compliance.  The ideal candidate will research, analyze and resolve complex issues. They will also be responsible for contract configuration, capitated risk, and division of financial responsibility interpretation, contract rate and language negotiation and interpretation, claims payment and member or provider eligibility.
This is a Full Time, Salaried position located at our Scripps Financial Office in Rancho Bernardo/4S Ranch.

Job Requirements

Required Education/Experience/Specialized Skills:
  • Bachelor's degree I business/health care field or equivalent experience.
  • Minimum 5 years managed care experience with working knowledge of full risk and shared risk arrangements, utilization management, claims, and enrollment/eligibility.
  • Financial/auditing background.
  • Exceptional customer service skills with prove ability for effective follow-up.
  • Claims payment, contract interpretation and knowledge of contracting terms required.
Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, the only San Diego-based company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.