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Contracts Admin

Company: On Lok Senior Health Service
Location: Fremont
Posted on: June 10, 2021

Job Description:

On Lok PACE

We are a non-profit committed to our participants.

Dedicated to The Care of Elders:

PACE (Program of All-Inclusive Care for the Elderly) was developed to answer the many problems around caring for frail seniors. The PACE model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in their community whenever possible.

Seniors, their family members, and caregivers face many issues, including transportation to appointments, management of medications, coordination of medical care from different specialists, lack of social interaction, and ability to stay alone at home. On Lok PACE participants receive in home care services and transportation to a On Lok PACE center for primary medical care, social and recreational activities, and other senior care services.

We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare.

Join our team of leaders to begin a rewarding career!

POSITION SUMMARY: Under the direction and supervision of the Provider Services Manager, the Contract

Administrator negotiates and implements contracts with outside healthcare providers

providing PACE services to On Lok Participants.

DUTIES / RESPONSIBILITIES:

  1. Effectively negotiate and implement healthcare contracts with physicians/other professionals, nursing homes and

ancillary (including ambulance, DME, home health/hospice, imaging, lab, RCFE) providers that meet

reimbursement goals within approved authority limits.

  1. Develop and maintain working relationships with outside provider community for both existing provider network

and potential new network providers.

  1. Effectively negotiate and implement individual letter of agreements within approved authority limits.

  2. Acts as primary point of contact for contract interpretation, and for contract dispute related to claims inquiry.

  3. Maintains working knowledge of PACE, DHCS and Knox Keene regulations pertaining to provider contracts.

  4. Maintains working knowledge of reimbursement methodologies related to Medicare and Medi-Cal such as

RBRVS, PPS, RUGS and lab/ambulance.

  1. Provides input and participates in strategic planning efforts.

  2. Maintain contract files both soft and hard copy format.

  3. All other reasonably related duties as assigned.

QUALIFICATIONS (knowledge, skills, abilities):

  1. Minimum BA in business, healthcare management or other relevant discipline.

  2. Three to five years' experience in a managed care field working with payors/providers in contract negotiations.

  3. Detail oriented accuracy.

  4. Ability to establish negotiating strategies that leads to successfully implementing contracts.

  5. Ability to establish priorities and goals including workflow/project management and organization skills.

  6. Strong communication skills, both oral and written.

  7. Familiarity with Microsoft Office including Excel, Outlook, and Word.

  8. Ability to learn proprietary database(s) such as electronic medical record and claims payment system.

  9. Occasional travel to provider locations in SF, Fremont and San Jose area.

On Lok's Employee Benefits include (eligible for any position for 20 hr/wk or more):

  • Medical, Dental, and Vision coverage
  • Retirement Savings Plan 403(b) and Term Life/AD&D Insurance
  • Flexible Spending Account, Commuter Checks, MLA scholarships, Employee Assistance Program (EAP)
  • Pet Insurance and additional discounts
  • Holidays (10 per year), vacation time, sick leave, and long-term disability insurance

Pursuant to the San Francisco Fair Chance Ordinance, and state and federal laws (including federal PACE requirements at 42 CFR 460.64(a); 460.68(a), we will consider for employment qualified applicants with arrest and conviction records.

On Lok is an equal opportunity employer committed to a diverse and inclusive workforce. All applicants will receive consideration for employment without regard to sex (including pregnancy), race, religion, color, gender, gender identity, gender expression, sexual orientation, national origin, ancestry, disability, medical condition, genetic information, marital status, age, military or veteran status, or any other legally protected status.

If you require reasonable accommodation to participate in the job application or interview process, to perform essential job functions and/or to receive other terms, privileges or benefits of employment please contact Recruitment (recruitment@onlok.org).

Keywords: On Lok Senior Health Service, Fremont , Contracts Admin, Other , Fremont, California

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