Heathcare Contract Specialist - 4 Month Contract

CONTRACTS SPECIALIST

DESCRIPTION:

Coverage for 2 FTEs that have been assigned to a large project beginning this fall. There may be some overlap.

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Support the Contracts Admin team in the composition of EOC books for Mid Large and Private Exchange Book
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Support the Contracts Admin team in breaking out the EOC books for Mid Large and Private Exchange books
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Support the Contracts Admin team by proofing/reviewing items received back from ODS (third party vendor that prints the EOCs)
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Support the Contracts Admin team by performing QA on EOC books as requested
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Support contractual leadership and expertise to the contract administration department by taking responsibility for the coordination, implementation and administration of the Region's contracts and benefits which include:

Participating in cross-functional work efforts related to the clarification, interpretation, benefit administration, pricing activities and medical policy development; and

Creating written materials used to communicate with regulators and internal stakeholders.

ACCOUNTABILITIES:

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Responsible for ensuring the issuance, accuracy and compliance of all the Health Plan's group, non-group, and ancillary benefit plans, contracts, forms and evidence of coverage (for both new products and existing products) in accordance to regulatory statues, lines of business and timelines.
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Responsible for on-going development and administration of Health Plan benefit contracts and related documentation for an assigned product segment- to include EOC filing, composition, production and distribution.
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Oversees the on-going administration of the region's Federal contract with the Office of Personnel Management including the annual benefit submission and on-going reports. Maintains relationship with OPM on a local level. May also support initiatives for CMS-Medicare.
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Researches and stays abreast of regulations and statutes. Determines impacts of implementation of new regulations and statutes and provides feedback.
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Communicates required changes to relevant business partners, develops tools to assess risks, and leverages existing workgroups/etc to facilitate required changes. Representative on appeals committee.
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Performs peer review of filing updates/changes completed by other member of the Contracts Admin Team. Responsible for working with various departments (outside of Contracts Admin) to ensure QA is completed on all filing forms, QHP documentation or customer inquiries.
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Oversees the implementation, development and on-going administration of the region's Medicaid contracts related to member handbook requirements (including the annual benefit submission and on-going reports).
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Serves as the primary resource for resolution of benefit and contractual clarification issues. Familiar with ICD 10, CPT and other benefit classification/coding tools to ensure appropriate medical definition and benefit rules.

Provides strategic input into the benefit designs for products such as POS, OOA, Medicare, Self-Funding, Medicaid etc. to expedite regulatory filing and approval cycle.

REQUIREMENTS:

Minimum 5 of years of experience

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Five years of healthcare experience - (health care operations (quality, risk, etc), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan government experience)with a minimum of 2 of those years of experience in a regulatory, legal or healthcare benefits related activity.

BS/BA in marketing, healthcare or related field (Master's Degree in liberal arts, health care (or related field) or JD preferred or equivalent years of experience combining undergraduate level studies and work experience in a compliance of legislative role preferred)

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Knowledge ofHealth care, benefits, and/or insurance experience
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Ability to effectively use PC/laptop (specifically Microsoft Office and Adobe)
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Working knowledge of Federal HMO LawsOPM/FEHB Regulations; State laws such as Maryland & Virginia HMO LawsFederal TEFRA, COBRA, Medicare and Medicaid Lawsand Maryland COBRA Laws
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Excellent written and oral communications skills
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Ability to work in a team
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Demonstrated ability to effectively use PC and/or Mainframe computers required.
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Knowledge of medical terminology, benefit coding, and clinical procedures preferred.
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Experience and knowledge of benefit, MCO or provider contracts preferred.

Knowledge of project management, spreadsheets, presentation graphics, and word processing preferred.

WHAT I AM REALLY LOOKING FOR IS TWO RESOURCES WHO CAN PICK UP CONCEPTS QUICKLY, FOLLOW DIRECTIONS AND ASK FOLLOW UP QUESTIONS WHEN THEY NEED TO.