Contract Implementation Coordinator Jobs

About the Role

The Contract Implementation Coordinator is responsible for ensuring a successful implementation through orchestrating the creation, implementation, and maintenance of provider contracts. Perform and lead the setup, configuration and testing to ensure proper functionality and proper execution.

Job Responsibilities

• Coordinate all process flow activities relating to provider agreements and amendments.
• Develop and maintain implementation overview documents.
• Maintain Hospital/Provider Spreadsheet document containing various reporting elements including but not limited to hospital demographics, covered products, key contract terms, etc.
• Develop internal and/or external rate sheets for system programming.
• Maintain implementation tracker and perform ad hoc reporting.
• Coordinate appropriate contract set up and loading in conjunction with other departments.
• Support Network Management Team when required for any projects, escalated issues, etc.
• Conduct post implementation reviews of provider arrangements to confirm contracts are implemented appropriately and claims will process as expected.
• Maintain electronic and paper filing of all provider correspondence including contracts, rate sheets, official correspondence, and working files.
• Support Network Operations and/or Network Management in all aspects of rate sheet development and implementation.
• Distribute internal communications related to implementation process, including but not limited to reports, rates sheets , training documentation, etc.
• Serve as liaison between Network Operations and internal departments as it pertains to escalated claim issues and other provider issues needing resolution.
• Participate in research and development of processes & protocols for contracted rate implementation such as observation, ambulatory surgery tables, etc.

Essential Qualifications

• Knowledge of the health insurance industry; such as products and services.
• Ability to maintain professional demeanor under pressure.
• Work well independently and as a team player.
• High School Diploma, Bachelor’s Degree preferred or equivalent experience is acceptable.
• Detail oriented with excellent organizational and time management skills.
• Minimum of 5 years managed care equivalent experience, preferably in a Network Operations or Contract Implementation role.
• Strong knowledge of claim processing, such as CPT Codes, HCPCS Codes, ICD-10 Codes, etc.
• Experience with Impact Database a plus.
• Capable of managing multiple complex issues at the same time.
• Superior oral and written communication skills.
• Strong critical thinking, investigative, analytical and problem-solving skills.
• Must be proficient in Microsoft 365, (Microsoft Outlook, Teams. Word, Excel, and Power Point)

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

DEI Purpose Statement

At BHPS, we encourage all team members to bring your authentic selves to work with all of your unique abilities. We respect how you experience the world and welcome you to bring the fullness of your lived experience into the workplace. We are building, nurturing and embracing a culture focused on increasing diversity, inclusion and a sense of belonging at every level.

*We are an Equal Opportunity Employer