LOCATION: Remote

GENERAL STATEMENT OF JOB:

This position will assist the Provider Network Operations (PNO) team in the day to day operations of managing contracts assigned to the department. This position will perform day to day duties and testing of contract implementation, including UAT to ensure that systems accurately reflect a contract’s negotiated terms. The position will assist the Legal team in prioritizing PNO related contracts and amendments and track all contracts through the system to full execution.

NOTE: This position requires access to and use of sensitive information, including protected health information (PHI). As such, the individual filling this position shall complete privacy and security training and shall comply with applicable laws, rules and regulations in their capacity as an employee of Vaya Health. The individual filling this position shall also sign an annual confidentiality agreement/ attestation as an employee of Vaya Health.

ESSENTIAL JOB FUNCTIONS:

Contract Management-

• Track and manage all PNO related contracts across the contracting process
• Create contracts and manage contracting process utilizing the Contract Management System to ensure that new business contract deadlines are met.
• Maintain spreadsheets and databases; collect, track, prepare, compile, and distribute statistical data for daily and ad hoc reports.
• Interface with provider enrollment staff to ensure data and systems are in sync.
• Provide support to contract negotiators to ensure successful completion of contracting process.
• Identify gaps and risk in contracting process and coordinate with multiple departments to ensure contracting process is completed timely and accurately and within required established standards and guidelines.
• Maintain physical and electronic file systems.
• Provide support to other departments to ensure compliance with internal contracting standards.
• Assist in priotizing contracts that are of high priority for PNO
• Assist in the review, development, and auditing of contract Scopes of Work being generated by PNO
• Assist with audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing
• Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests
• Troubleshoot and problem solve contract implementation issues related to basic system configuration
• Review contracts and assign pay classes and applicable provider information based on contract language. If configuration is needed to accommodate a contract, notify the appropriate parties.
• Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments
• Review new and current provider contracts and established state guidelines

Network Management

• Will follow up with provider contract status requests
• Will support the Provider Support Line on provider questions
• Will support the provider services email on provider related questions

Other duties as needed/assigned

QUALIFICATIONS & CREDENTIALING REQUIREMENTS:

Required: Bachelor's Degree in Business, Finance, Legal or related field, or equivalent experience.

Years of experience: 1+ years of provider contract implementation, contract analysis or claims analysis experience in managed care, health care or TPA setting. Government programs experience preferred

PHYSICAL REQUIREMENTS:

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work.

KNOWLEDGE OF JOB:

• Knowledge of office and business practices in the completion of daily responsibilities.
• Maintain knowledge of changes in policy, methods, computer operations, equipment needs, etc., as they pertain to departmental operations and activities.
• Knowledge of Contract Management platforms and business processes
• Able to communicate effectively and have daily interpersonal contact with the public, providers, supervisors, and other employees.
• Ability to assemble information in a concise, clear, and effective manner.
• Able to use independent judgment as situations warrant.
• Ability to comprehend, interpret and apply regulations, procedures, and related information.
• Adept at producing and interpreting management reports for internal and external audits and senior management.

RESIDENCY REQUIREMENTS:

The person in this position IS required to reside in North Carolina or within 40 miles of the NC state line.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open until filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit http://www.vayahealth.com/careers-overview/ Ind.001

Vaya Health is an equal opportunity employer.

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