San Carlos, CA
SleepQuest, Inc. is a rapidly expanding National Health Services Company focused on Sleep Related Breathing Disorders. We have provided sleep care services for over 20 years with a comprehensive “continuum of care” that includes diagnostic sleep testing, titrations, and CPAP treatment for obstructive sleep apnea (OSA).
We are currently seeking a Healthcare Contract Administrator. This individual is responsible for the negotiation and maintenance of all healthcare contracts and provider credentialing files. Key factors include supporting the sales growth by negotiating new contracts with payers and expanding services with payers that have existing contracts. The position administers the entire contract process from pre-contract through post-signature phases, reports to the Medical Billing Manager and closely collaborates with the sales team and internal departments to ensure staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers we serve.
Responsibilities include the following:
- Negotiate and maintain contracts with all payers, e.g., insurance companies, MSOs, IPAs, TPAs and government programs. This includes supporting the expansion into new markets.
- Assure contractual arrangements meet financial targets and legal/regulatory compliance requirements. There will be an emphasis on analyzing cost and utilization data.
- Facilitate the approval process of all contract documents from pre-contract through post-signature phases.
- Responsible for the accuracy of supporting documentation for contracts and completing documents accurately.
- Develop and maintain processes that provide timely notification of critical contract and provider credentialing events (e.g., renewals, termination and due dates contained within the agreements).
- Maintain existing relationships with contracted providers. Ensure contractual language is kept current; evaluate fee schedule quarterly to identify possible opportunities for additional covered services, medical policy changes and reimbursement.
- Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy & billing policies.
- Develop and maintain periodic, e.g. quarterly, reports on the status of all contracts.
- Assure accurate data entry of contract specifications and terms into database and completeness of all contracting and provider credentialing processes.
- Maintain excellent written and verbal communication with all internal and external customers.
- Effectively and professionally represent SleepQuest to the provider community.
- Assist with all contracting administration and projects, as needed.
Qualifications and Experience:
- Minimum of 2 years of relevant experience in the sleep industry, DME, hospital, clinic, physician, and/or primary care and health system contracting is highly preferred
- Bachelor’s Degree or equivalent experience
- Strong demonstrated knowledge and understanding of healthcare industry, legal and regulatory requirements
- Willingness to actively participate in all aspects of the contract and provider credentialing administrative processes. This is a hands-on working role as opposed to a lead and direct staff role.
- Exceptional and proven provider partnership skills and interpersonal skills
- Ability to develop and deliver presentations to internal and external groups
- Results driven, persistent – able to self-direct and work independently showing initiative, while seeking guidance when appropriate.
- Ability to multi-task, pay close attention to detail and be flexible in a fast paced and growing organization
- Strong organizational and analytical skills
- Demonstrated strength in computer software, e.g., MS Office Suite, PowerPoint, social media and internet-based research.
- Experience working at a medical insurance company, MSO, IPA, TPA highly preferred
- Knowledge and use of Brightree software, preferred but not required.
SleepQuest offers competitive pay and a comprehensive benefits package, to include Medical/Dental/Vision/FSA/Life Insurance coverage, a 401k program with company sponsored match, and vacation & holiday pay.