Senior Provider Relations/Contract Specialist
Job Description
This is a full-time, benefited position. Must be local in San Diego or willing to relocate. The ideal candidate will be someone who is experienced with Provider Relations, Managed Care Background, has worked for a Medical Group or Health Plan, and is committed to delivering exceptional customer service.
Join the Scripps Health team and work alongside passionate caregivers and provide patient-centered healthcare. Receive endless appreciation while you build a rewarding career with one of the most respected healthcare organizations nationwide.
Why join Scripps Health?
AWARD-WINNING WORKPLACE:
- #5 in Fortune Best Workplaces in Health Care 2023
- #78 in 2023 PEOPLE Companies that Care
- #95 in Fortune 100 Best Companies to Work for 2023
- Recognized by Newsweek as one of America's Greatest Workplaces for Diversity in 2024
- Nearly a quarter of our employees have been with Scripps Health for over 10 years.
The Senior Provider Relations / Contract Specialist is the liaison between the medical groups, network providers and Scripps Clinic Health Plan Services. Decision making authority regarding processes related to the contractual arrangements. Responsibilities may include, but are not limited to: reporting, auditing, documentation, communication, training and effective resolution of issues. Ensures exceptional customer service and builds effective relationships between the organizations. Attends meetings at medical groups to provide input and support in relation to managed care. Thoroughly researches issues and interacts with management in Managed Care Operations to facilitate effective processes. Assists in network contracting ensuring ease of implementation of contracts and standardization of rates whenever possible.
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.
Preferred Education/Experience/Specialized Skills/Certification:
- Experience with Provider Relations.
- Worked for a Medical Group or Health Plan.
- Epic Tapestry experience
- MD-Staff experience.
- Managed Care Background.
Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, status as a protected veteran, among other things, or status as a qualified individual with disability.
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