Director of Contracting

Responsible for overseeing the day-to-day operations of contracting for Desert Oasis Healthcare.

• Participate in the development of financial and/or operational goals and actively contribute to the achievement of assigned financial and/or operational goals.
• Oversees day-to-day operations of the Desert Oasis Healthcare specialty and ancillary contracting including, but not limited to, management of Contract Specialist and interfacing with physicians, patients and health plans as needed.
• Works with providers to resolve provider performance and compliance concerns, and questions regarding provider contracts and payment for services rendered.
• Maintains specialist and ancillary contract and correspondence files.
• Maintains and distributes the internal central contracts matrix for ancillary and specialty providers to appropriate staff.
• Responsible for meeting governmental requirements and regulations specific to contracting, i.e. AB1455 and new regulation changes. Revises and maintains all contract templates.
• Negotiates provider agreements and presents to management for final approval.
• Responsible for preparation, negotiation and approval of routine LOA’s and one time agreements as needed.
• Reviews and approves Specialist network split matrixes and Specialist capitation payments.
• Handles PPO negotiations and follows up on contract issues.
• Responsible for Business Associate Agreements.
• Responds to all health plan and staff contract questions.  Prepares and oversees contract audits and other contract related requests.
• Works closely with Senior Management in identification of contracting, financial process, and improvement opportunities.
• Assists Compliance with downstream provider audits as needed.
• Manages ACO (or subsequent Federal program) provider contracting, data bases, and other reporting requirements as directed by management.
• Validate Specialty capitation rates and various Specialist cap deductions withholds.
• Assists with the following contract responsibilities as needed:  NextGen, NurseCom, Televox, and other contracts as requested.
• Other duties as assigned

Qualifications

• High school diploma or equivalent required. Bachelors degree in Business Administration, Finance, Healthcare, or closely related field preferred.
• 5 years recent experience in contracting (Hospital/MSO/Medical group) and knowledge of contracting language and terms required. Negotiation and leadership experience preferred.
• Excellent customer service skills.
• Must possess strong organizational, inter-personal skills and excellent oral and written communication skills.
• Good communication skills, detail oriented, critical thinking and problem solving skills.  Excellent customer service and telephone etiquette skills.
• Current California drivers license and proof of insurance.
• Able to work independently.