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Provider Contract Specialist

Posted on Jun 14, 2019 by Wellcare

Cypress, CA 90630
Immediate Start
Annual Salary

The incumbent will be responsible for supporting business people in our local WellCare markets in negotiating contracts with hospitals, physician groups and other providers to participate in our provider network, including taking a major role in reviewing, analyzing and drafting contract language as part of those negotiations. This role will also support other legal matters related to provider relations, including assisting with disputes, provider manual support, provider communication review and other issues.

Department: Legal

Location: Cypress, CA

Reports To: Senior Manager Provider Contracts

Essential Functions:

  • Collaborate with Network representatives and WellCare attorneys in various markets on all aspects of contracting with new and existing providers in networks across several states
  • Support strategic positioning for provider contacting, assist in development of contract templates and help identify opportunities for great value-orientation and new payment methodologies
  • Contribute to development of alternative networking initiatives and new provider business strctures
  • Support attorneys and clients on provider relations issues
  • Perform other duties and work on projects as assigned
Additional Responsibilities:

Candidate Education:

  • Preferred A Bachelor's Degree in a related field Business, Finance or Accounting
  • Preferred Other If a paralegal, certification/degree with contract specialization
Candidate Experience:
  • Required 5 years of experience in Front line provider contracting supporting a health plan, health insurance company or hospital/physician network in either business or legal department
Candidate Skills:
  • Advanced Ability to communicate and make recommendations to upper management
  • Advanced Ability to drive multiple projects
  • Advanced Ability to effectively present information and respond to questions from peers and management
  • Intermediate Ability to influence internal and external constituents
  • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
  • Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
  • Advanced Ability to work in a fast paced environment with changing priorities
  • Advanced Demonstrated written communication skills
  • Intermediate Knowledge of healthcare delivery
  • Advanced Demonstrated problem solving skills
  • Advanced Demonstrated analytical skills
  • Intermediate Ability to work independently
  • Advanced Ability to work within tight timeframes and meet strict deadlines
  • Advanced Demonstrated negotiation skills
  • Intermediate Ability to work in a matrixed environment
  • Intermediate Ability to analyze information and convert related activities into a comprehensive work plan
Licenses and Certifications:
A license in one of the following is required:
  • Preferred Other If paralegal, certification
Technical Skills:
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft PowerPoint
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Word
  • Required Intermediate Other Emptoris or other contract management software experience

    About us
    Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at . EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

    Reference: 720881915