Reporting into the Vice President of Contracting, the Contracts Implementation Consultant (âœCICâ) is the contracting department liaison responsible for supporting the company in the implementation of provider and health plan contracts to ensure accurate interpretation and operationalization of contract terms. The CIC coordinates activities and information exchange between the Contracting Department, internal operations/business units, information services, and contracted entities. The CIC ensures that contracts, including benefits, products and programs, are implemented correctly and in a timely manner across the organization.
Establish and lead multi-departmental work groups to operationalize provisions of new contracts. Identify and resolve issues related to new and existing contract requirements. Collaborate with and guide appropriate departments to ensure that required policies and procedures are shared, understood and implemented and monitored in a timely manner. Provide descriptions of applicable health plan products or programs, and identify any unique operational requirements or obligations (e.g., narrow networks, performance programs).
Establish and facilitate work groups to provide oversight of existing contracts. On an ongoing basis, monitor, and ensure accurate and consistent interpretation of existing products and programs, and facilitate correction plans as necessary.
Act as key liaison from the Contracting Department for health plan issues and questions for all internal departments.
Act as liaison from the Contracting Department for Joint Operations Committee (JOC) meetings, working with Contract Managers and applicable Hill Physicians departments to establish agendas and coordinate meetings. Maintain record of unresolved health plan issues, and coordinate resolution of such issues.
Monitor all health plan communications sent to PriMed and/or Hill Physicians as well as to individual physician practices (when known), and distribute such communications internally, as appropriate, to ensure all stakeholders are informed of applicable information. Work with appropriate departments to modify existing policies to comply with health plans. When necessary, initiate and coordinate meetings with applicable departments to ensure policy and operational compliance.
Monitor legislative and regulatory requirements that relate to operations, and recommend and coordinate implementation strategies to comply with such requirements, as communicated by health plans, regulatory agencies or PriMed / Hill Physicians. Communicate to applicable departments any legislative changes impacting the operational obligations of PriMed / Hill Physicians with its health plans. Assist the Contracting Department, as necessary, to implement such changes in contracts.
Work closely with appropriate departments to develop training materials to ensure that all necessary staff are educated and trained to consistently administer health plan and provider contracts.
This position will also have additional departmental responsibilities which include, but are not limited to â“ assisting the Vice President with facility and/or ancillary contracting duties, contributing to the development and implementation of a new provider data base system (Vistar), and other departmental duties as required.
Knowledge, Skills and Abilities
Required Experience -
Minimum 3-5 years of managed care industry experience.
Exceptional written and verbal communication skills, including public speaking and facilitation skills. Strong desktop application skills including Word, Excel, and PowerPoint, database management skills a plus.
Ability to identify and define work process issues and work collaboratively to find solutions.
Strong project management skills.
Effective at working independently and in partnership with key internal stakeholders. Able to develop constructive and credible relationships with external business partners.
Must be able to successfully and simultaneously manage multiple projects and deadlines.
Bachelor's degree required
Hill Physicians is an Equal Opportunity Employer
For more information, please visit www.hillphysicians.com/careers