Contract Specialist

Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

Responsibilities

Job Summary / Purpose

The Contracting Specialist will work closely with the Market Director, Employer Strategy and Relations to ensure Clinically Integrated Network (CIN) services are being provided to employer groups per their individual agreements. The primary responsibility of the Contract Specialist will be member engagement to promote network steerage and supporting the expansion, maintenance and promotion of the CIN.

Essential Functions

• Identify and engage with benefit plan members regarding network steerage
• Monitor health benefit claims for utilization trends outside of Enhanced Network and report trends to Director or identified team member
• Engage with new benefit enrollees regarding understanding of Enhanced Network benefits
• Outreach to members and/or promote network utilization determined by clinical focus area of CIN
• Identify and engage with medical plan benefit members who have not selected a primary care provider (PCP) and schedule appointments as appropriate
• Per individual employer agreements, provide direct scheduling within Enhanced Network
• Document all member outreach attempts and engagement in the CIN’s data & analytics platform for reporting, tracking and productivity reports
• Will perform strategic project assignments as implemented by Director
• Engage with assigned provider offices as identified by Network Development Specialist
• Work with Market Director on any community events that promote the CIN and/or active employer strategies
• Conduct evaluation & preparation aspects of facility or provider service contracting
• Notify contracted parties of any changes to contract, compliance requirements or termination
• Maintain the contract administration system and file records accordingly
• Ability to navigate, document, and utilize platforms including but not limited to (Innovaccer, EPIC, ACO MS, Meditract, KHIE)

The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.

Qualifications

Education and Experience

• High School Diploma or GED
• 5 years’ experience in healthcare related field and/or,

• 5 years’ experience in customer service, sales, account management or related field