Senior contract specialist job description

Your Role

The PPO Professional Provider Contracting team manages our PPO network to maintain network adequacy by contract negotiation, recruitment and building/maintaining professional relationships. The Provider Contracting Specialist Sr. will report to the Provider Contracting Manager. In this role you will ensure the acquisition, servicing and performance of Physicians/Medical Groups and other Specialty Network Providers to the Blue Shield of CA contracted network. Support attainment of department goals under the leadership of the Director of Provider Contracting and/or Provider Contracting Manager and ensures alignment of these goals with the company's strategic priorities. Supports review and modification of contracting and cost of health care savings strategies in anticipation of, and in response to, shifts in provider and competitor negotiating approaches. Research opportunities within the assigned local market (i.e., network expansion opportunities, utilization, or unit cost excesses, etc.) and assesses market trends to drive initiatives which enhance company's market position. Other duties as assigned.

Your Work

In this role, you will:

Participate in cross-functional team to implement initiatives to help manage the total cost of health care across the assigned region
Collaborate closely with Medical Management, Provider Relations, Network Analytics and Sales to meet aggressive regional goals
Drive alignment with Pricing, Underwriting and sales regarding unit cost and other contracting activities
Identify strategic opportunities within local market (i.e., network expansion opportunities, utilization or unit cost excesses, etc.)
Assess market trends and competitive benchmarks to enhance company's market position
Negotiate and finalize Independent Provider Agreements including value-based payment models for primary care and other specialty network contracts based upon network analysis and established parameters as directed by Director of Provider Contracting and/or Provider Contracting Manager
Manage contracting efforts through entire procurement process (end to end) to ensure contracts are administered and implemented accurately.
Assist with recruitment strategies for targeted providers.
Collaborate with the contracting leadership team to ensure best practices in negotiations to achieve aggressive unit cost and overall health care cost targets

Responsible for the strategic development and administration of contracts with State and/or Federal governments for Medicaid, Medicare, Marketplace, and other government-sponsored programs to provide health care services to low income, uninsured, and other populations.
KNOWLEDGE/SKILLS/ABILITIES



Responsible for coordinating, conducting and/or responding to research requests pertaining to government healthcare programs; preparing and submitting regulatory reports for filings; reviewing Plan submissions for quality, accuracy, and timeliness; and ensuring Plan meets contractual and regulatory requirements.
Reviews Provider Agreement, EOC/ Member Handbook, Provider Directory, marketing materials, and other contract reporting deliverables for compliance with contractual and regulatory requirements prior to submission.
Assesses information received from government contracting agencies and regulators and disseminates to impacted Plan staff.
Participates in meetings related to Molina government run programs with State agencies and Molina Corporate departments and disseminates relevant information to staff and management.
Oversees/maintains the department's documentation and archive system, ensuring submitted reports are archived for historical and audit purposes. Ensures system is updated and complete.



JOB QUALIFICATIONS


Required Education


High School diploma or equivalent


Required Experience



3 years' experience in a managed care environment.
Experience demonstrating strong: communication and presentation skills; analytical/reasoning ability; detail orientation; organizational and interpersonal skills.
Proficient in compiling data, creating reports, and presenting information, using Crystal Reports (or similar reporting tools), SQL query, MS Access, and MS Excel.



Preferred Education


Bachelor's Degree in Business Administration, Healthcare, or related field.


To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.


Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V


#PJHPO #Li-BeMore

The Senior Vendor Management Contract Specialist will support the Vendor Management Office (VMO) in the management, development, maintenance, and governance of the Bank's third-party risk management (TPRM) program. The incumbent will develop, recommend, and deploy policies, procedures, and tools required to manage and oversee vendor risk with the first and third lines of defense. The incumbent will also assist with the deployment of vendor risk management processes enabling adoption, compliance, and training throughout the Bank while keeping abreast of regulatory changes and incorporating those changes into the TPRM. The Senior Vendor Management Contract Specialist will assist in the vendor selection process, manage the scope of work, and assist in the due diligence process with the vendor and functional groups within the Bank. The incumbent should understand the Requests for Proposal (RFP) process and promote clear interpretation and adherence to regulatory guidelines set forth by the OCC, FRB, and CFPB. The incumbent will negotiate contract terms with vendors based on business needs and legal guidelines and assist business units in determining service-level agreements. The Senior Vendor Management Contract Specialist will manage a schedule of Third-Party Assessments, ensuring a summary regarding the nature of Third-Party Performance is rendered and supported, and gather and assess data and documentation necessary.
Responsibilities:

* Monthly meetings with each line of business to discover what vendors are active and incoming, if any
* Review contracts as submitted and determine contracts' criticality. Facilitate review with outside counsel, if necessary
* Review agreements, addendums and statements of work and redline, where necessary
* Ensure all contracts are entered into the system of record in a timely manner and updated as changes occur.
* Complete contract checklist
* Work with VMO team to ensure due diligence is completed on all contracts
* Maintain awareness of contracts that are set to expire and handle the termination letter process with applicable parties
* Multitask assignments and prioritize contracts based on criticality
* Identify issues as they arise and work them to closure, escalating when appropriate.
* Other duties as assigned

Minimum Qualifications:

* Bachelor's Degree in Business Administration, CIS, Finance, or equivalent combination of education and experience in vendor management, contract management, and/or other relevant experience.
* Must have 3-5 years of experience working with contracts and/or paralegal work required
* Third Party Risk certification or the desire to attain is required
* Must possess the ability to identify issues and work them to closure, escalating when appropriate.
* Must be able to understand and apply federal banking guidelines and regulations.
* Must have experience managing complex and dynamic enterprise vendor risk management functions.
* Experience in negotiating complex and dynamic legal documents is preferred
* Must have experience working across a diverse set of stakeholders with positive results.
* Must possess the ability to work collaboratively with a broad range of constituencies.
* Must have strong written and oral communication skills.

Inclusiveness:

WSFS Bank is inclusive and supportive of individual needs. If you have a physical or other impairment that might require an accommodation, including technical assistance with the WSFS Bank Careers website or submission process, please contact us via email at careers@ wsfsbank.com.

WSFS is an equal opportunity employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

#LI-Hybrid