Contract Specialist

RI International is a global organization with more than 50 programs located throughout the United States and abroad. We continuously work to strengthen our position as the worldwide leader of mental health and substance use crisis service design delivery as well peer delivered care.

Our Mission is to empower people to recover, succeed in accomplishing their goals, find meaning and purpose in life, and reconnect with themselves and others.

Our Vision is to activate the next generation of frame-breaking healthcare innovation to support people beyond their behavioral health needs and succeed in the community where they live, work, and play.

Salary/Hour Wage

$27-$28/hour

Job Type

Full-Time: Non-Exempt

Shift

Day

Shift Hours

8:00am to 5:00pm

Specialties / Licenses or Certifications

N/A

Work Setting

Remote

Our Position

The Contract Specialist III will provide support to the Contract and Rates Administrator within a multi-state, multi-contract environment by preparing contract documents and proposals. The Contract Specialist will work with payers to update, change, or amend existing payer contracts and assist with new state and program implementations.

Your Responsibilities

• Research and analyze billing guides, service definitions, fee schedules
• Ability to do extensive and consistent follow-up with payer/funders to ensure contracts are updated and or revised in a timely manner to meet the needs for rates and submission of claims in a timely manner.
• Develops reporting data and files, as needed, and as requested.
• Proactive out-reach to targeted payers/funders for adequacy and gaps in network and other projects as assigned
• Outreach for new provider contracts, amendments, and other types of agreements in a timely manner
• Assist Contracts Manager with evaluating team members, hiring and onboard new staff providing routine feedback, training, and educating staff on systems, processes, and payer nuances as needed
• Collects signed contracts, amendments, and other documentation
• Create Service Requests for contracts/amendments to be loaded in claims/configuration system
• Ability to handle multiple priorities with deadlines
• Coordinates the distribution of contracts and amendments within specific time limits
• Works closely with other departments on new business projects
• Attend monthly Provider Network and/or Operations meetings
• Performs other position appropriate duties as required in a competent, professional, and courteous manner
• Assist with educating, training, and mentoring of new and established staff contract administration database and the process for contract review and approval, including day-to-day ad-hoc instruction and guidance for internal users.
• Assist in the development of contract proposals
• Assist in the assessment of contract performance to identify the need for amendments to existing contracts.
• Collaborate with Program leaders to update, change, or amend existing payer contracts
• Serve as a liaison with external contracting representatives
• Continuously maintain and update the contract management system: Credential Stream and serve as a super user.
• Assist with new state and program contract implementations
• Initiates, negotiates, generates, and tracks provider Letters of Agreement, contracts, and amendments from initial draft to full execution utilizing approved standardized contract templates/amendments.
• Supports network development throughout state to including researching, recruiting, and negotiating with providers.
• Participates in the evaluation of provider network and implementation of strategic plans to meet Molina's network adequacy standards.
• Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital, and ancillary providers.
• Assists in analysis and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided, and other information needed to complete the contract profile.
• Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes.
• Understands and adheres to RI International compliance standards as they appear in the Code of Conduct and Conflict of Interest Policies.
• Performs other duties as assigned.

Our Requirements

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
• This is not safety-sensitive position.
• High School Diploma or GED required
• 3-5+ years of credentialing experience required and ability to negotiate and revise contracts in order to maximize cost effective care.
• Knowledge of managed care, Medicaid, Medicare, and/or health insurance industry
• Intermediate experience in Microsoft Office, including Excel.
• Detailed oriented, reliable, and able to multi-task in a fast-paced, high-volume work environment.
• Ability to maintain a high level of confidentiality (HIPAA guidelines and regulations) and professionalism.
• Must have a valid driver license and be 18 years of age.
• Must have the ability to walk, climb, stoop, reach, crawl, crouch, kneel, push, pull and lift a minimum of 10lbs.
• Must have excellent written and verbal communication, with particular emphasis during telephone calls, follow-ups, and in-person correspondence.
• We are a Second-Chance Employer
  • Must be able to pass a seven-year background check.
  • Must be able to pass substance abuse testing and/or tuberculous testing (if applicable).
  • Must be able to pass education verification check.
  • Must be able to pass three-year motor vehicle report and meet minimum eligibility requirements criteria of insurance carrier (if driving is required for this position).

Your Rewards

• Nine (9) company-paid Holidays (Full-Time Only)
• Paid-Time Off (Full-Time Only)
• Company-paid group life insurance (Full-Time Only)
• Medical, Dental, and Vision plans (Full-Time Only)
• Retirement Plans with Company match (401k/Roth)
• Employee Assistance Programs (Full-Time Only)
• Great Company Culture!

RI International is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, family or medical care leave, gender identity or expression, genetic information, marital status, medical condition, national origin, physical or mental disability, political affiliation, protected veteran status, race, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable laws, regulations, and ordinances. RI International is a second chance employer and we consider qualified applicants regardless of criminal histories, consistent with legal requirements. If you need assistance and/or reasonable accommodation due to a disability during the application or the recruiting process, please send a request via the Accommodation request form.

Benefits/perks listed above may vary depending on the nature of your employment with RI International.

The wage range for this role considers the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for any applicable geographic differential associated with the location at which the position may be filled. At RI International, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case.