Senior Provider Relations/Contract Specialist

About the role

This is a full-time, benefit eligible position that is partial remote located at our 4S Ranch office.

Responsibilities

• 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.
• Affords assistance in network contracting ensuring ease of implementation of contracts and standardization of rates whenever possible.

Requirements

• Minimum 5 years managed care experience.
• Exceptional customer service skills with proven ability for effective follow-up.
• Claims payment, contract interpretation and knowledge of contracting terms required.

Qualifications

• Bachelor’s degree in business/health care field or equivalent experience.

Skills

• Experience with Provider Relations.
• Worked for a Medical Group or Health Plan.
• Epic Tapestry experience.
• Contract financial modeling experience.

Benefits

In compliance with the California Pay Transparency Act, Scripps Health posts the pay range for all jobs. Please note that actual pay will be determined based on relevant experience and internal equity within the pay range. Please also note this range is applicable for employees who reside in California only. A geographical pay differential may be applied for remote employees who reside out of state. Scripps Health strives to ensure that our employees receive equal pay for equal work in line with our commitment to being an equal opportunity employer.

Pay

Please note that actual pay will be determined based on relevant experience and internal equity within the pay range. Please also note this range is applicable for employees who reside in California only. A geographical pay differential may be applied for remote employees who reside out of state.

Schedule

Shift: Day