Contract Analyst

POSITION SUMMARY

The Contract Analyst will be responsible for drafting, negotiating, and administering contracts with healthcare providers, vendors, and other stakeholders. This position evaluates all assigned contracts for compliance with regulatory requirements and organizational policies while optimizing the value and quality of services provided.

COMPLIANCE WITH REGULATIONS

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures and in compliance with applicable state and federal regulations including CMS and/or Medicare Part D, DHCS and DMHC.

RESPONSIBILITIES

• Contract Development and Negotiation:

• Draft, review, and negotiate contracts with healthcare providers, vendors, and other partners, as assigned by CHG contract management.

• Ensure contracts align with organizational goals, policies, and regulatory requirements.

• Collaborate with other departments to mitigate risks and resolve any contractual issues.

• Coordinate the flow of contracts by receiving, tracking, monitoring and storing contracts and disseminating contract information to appropriate staff; monitoring contracts by keeping a tracking log of all contracts produced, sent out and completed;

• Maintain systems/dashboards with updated data elements.

• Contract Management:

• Maintain a comprehensive contract management system, ensuring all contracts are up-to-date and accessible.

• Monitor contract performance, adherence to terms, and timely renewal or termination of contracts.

• Provide support and guidance to internal teams regarding contract interpretation and implementation.

• Organize work by providing administrative support functions including organizing correspondence, minutes, meetings notices and expense reports; reading and routing contracts for review and execution, preparing and routing correspondence; scheduling appointments; collecting information; maintaining departmental policies and procedures; initiating telecommunications; making recommendations to improve communication and efficiency.

• Regulatory Compliance:

• Stay informed of federal, state, and local regulations affecting managed health care contracts.

• Ensure all contracts comply with applicable laws and regulations, including HIPAA, Medicare, and Medicaid requirements.

• Conduct regular audits to ensure contractual and regulatory compliance.

• Assist with accurate and timely reporting of the provider network to all applicable regulators including but not limited to DHCS, DMHC, CMS and all internal stakeholders.

• Stakeholder Collaboration:

• Act as a liaison between the organization and healthcare providers, negotiating mutually beneficial terms.

• Facilitate effective communication and collaboration between internal departments and external partners.

• Address and resolve any disputes or issues arising from contract execution.

• Continuous Improvement:

• Identify opportunities to improve contract management processes and systems.

• Implement best practices and innovative solutions to enhance contract administration efficiency.

• Participate in professional development and stay updated on industry trends and changes.

• Perform periodic analyses of the provider network from a cost, coverage, and growth perspective. Provide leadership in evaluating opportunities to expand or change the network to meet Plan goals.

• All other applicable duties as assigned.

Qualifications

EDUCATION

• Associates Degree or vocational/specialized training. Equivalent to a Bachelor's degree in Business Administration, Health Services, or related field.

EXPERIENCE/ SKILLS

• 3 years related work experience involving provider services contracts or other forms of business contracts and analytical assignments.

• 5 years and in health care administration preferred.

• Strong understanding of managed health care plans and relevant regulatory requirements.

• Excellent negotiation, communication, and interpersonal skills.

• Proficiency in contract management software and Microsoft Office Suite.

• Exceptional attention to detail and organizational skills.

• Ability to work independently and as part of a team in a fast-paced environment.

• Certification in Contract Management (e.g., CCCM, CFCM, CPCM) (Preferred)

• Experience working with eVIPS and/or QNXT databases (Preferred)

• Experience working with government healthcare programs such as Medicare and Medicaid (Preferred)

• Knowledge of HIPAA and other healthcare-related regulations (Preferred)

PHYSICAL REUIREMENTS

• Prolonged periods of sitting and typing; speaking on telephone. Possible lifting of up to 15 lbs.

• May be required to work evenings and/or weekends; some driving within San Diego County may be required.

Must have current authorization to work in the USA

Community Health Group is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment based on any protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits and trainings. Community Health Group makes hiring decisions based solely on qualifications, merit, and business needs at the time. For more information, see Personnel Policy 3101 Equal Employment Opportunity/Affirmative Action.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.