Healthcare Contract Specialist - Ontario, CA(Job Number:701317)
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North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
The Healthcare Contract Specialist will be the primary contact for LOA negotiations with various Specialty and Ancillary providers, as well as for other network agreements such as radiology, dialysis, SNF’s, ASC’s, etc. They will also assist with hospital contract duties. Additionally, the Contract Specialist will be the primary manager of the shared contract database/intranet and will be responsible for ongoing maintenance of the tool.
Acts in the role of provider contracting resource for Market Executive Directors and their staffs
Assists and sometimes leads in preparation of provider contract proposals for negotiations
Develops and maintains tools for provider contract summaries
Provides reports and information as requested
Reviews provider contracts for accuracy and proposes revisions as needed
Assists in facilitating contract implementation through the distribution process
Evaluates or monitors provider contracts to determine necessity for amendments or extensions of contracts, and compliance to contractual/regulatory obligations
Assists with resolution of claims/operational issues or complaints as related to provider contracts
Primary contact for database projects and updates
Central contact for Provider Manual updates
Prepares and monitors all documents for scanning, with ongoing responsibility to ensure the accuracy of all scanned documents
Job Provider Contracting & Network Development
Primary Location US-CA-Ontario
Other Location US-California, US-CA-Los Angeles
Organization NAMM California
Number of Openings 1