Contracts Coordinator 1
This position coordinates a system of support for Nufactor Managed Markets and Operations; is responsible for the maintenance, organization and centralization of contracting efforts relating to Managed Care Organizations (MCOs), Preferred Provider Organizations (PPOs), Individual Practice Associations (IPAs), and Pharmacy Benefit Managers (PBMs).
Essential Functions and Duties:
- Work with multiple individuals/departments to maintain and update a Reimbursement by Health Plan spreadsheet. This includes:
- Pulling and updating multiple pricing methods (Redbook AWP, RJ Health AWP) quarterly
- Working with pharmacy purchasing for updated acquisition costs
- Requesting and updating multiple health plan fee schedules (updated quarterly)
- Researching Medicaid state fee schedules and update quarterly
- Coordinate price changes and fee schedules changes with the CPR+ Administrator. As needed create, update and maintain contract, pricing and insurance company information within the CPR+ software program and all systems of record on all new and existing agreements and as requested by the NuFactor billing/reimbursement department.
- Assist in maintenance of all contracting materials (agreements, amendments, database, etc.) related to all commercial, PPO/network, Medicare, Medicaid managed care and PBM contracts.
- Keep the shared Control Log, Workflow Spreadsheet and Signature Needed Spreadsheet updated with in-process and completed tasks.
- Assist Managed Market Directors in preparing/filling out applications, credentialing information, and LOAs, as well as gathering all associated required documents.
- Pull pricing from Reimbursement by Health Plan spreadsheet to prepare Pricing Proposals for Managed Markets Directors and others as requested.
- Work closely with multiple departments (Legal, Reimbursement, Managed Markets, Accounting, Compliance, etc.) to facilitate a timely review and approval of new Contracts and corresponding reimbursements, procure appropriate signatures, follow-up on countersignatures and effective date of agreement, and distribute needed information to sales and billing/reimbursement.
- Ensure all contracts, amendments and other payer legal documents are indexed and uploaded to the Nufactor shared drive, SharePoint, ConvergePoint and/or other contract databases as needed.
- Assist in the review of manufacturer and GPO contracts to ensure inclusion of standard terms, compare contract terms to ensure accuracy and track status of all in-process contracts.
- Assist Managed Care team in the preparation of bid responses, coordinate the collection of data from various company departments in support of bid preparation, and conduct comparison of old and new versions of contracts. Research and prepare forms for contract certification, regulation and vendor compliance. Assist with mailing, scanning and tracking of contracts and other documents as needed.
- Work with FFF marketing and Nufactor sales teams to create, maintain and update state and region lists of managed markets agreements.
- Provide timely, accurate and complete reports and information when requested.
- Adheres specifically to all company policies and procedures, Federal and State regulations and laws.
- Display dedication to position responsibilities and achieve assigned goals and objectives.
- Represent the Company in a professional manner and appearance at all times.
- Understand and internalize the Company’s purpose; Display loyalty to the Company and its organizational values.
- Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.
- Work effectively with co-workers, internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress, timetables, and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name, title, or other respectful identifier, and; respect the diversity of our work force in actions, words, and deeds.
- Comply with the policies and procedures stated in the Injury and Illness Prevention Program by always working in a safe manner and immediately reporting any injury, safety hazard, or program violation.
- Ensure conduct is consistent with all Compliance Program Policies and procedures when engaging in any activity on behalf of the company. Immediately report any concerns or violations.
- Other duties as assigned.
Education, Knowledge, Skills and Experience:
- Associates degree or additional preferred, high school with related work experience acceptable.
- General knowledge of concepts, practices and procedures related to the health care industry.
- Understanding of Managed Care, Health Insurance contracting, and drug pricing.
- Minimum two (2) years’ experience in relative health care industry including management, sales, clinic services or customer service.
- Two (2) years’ experience in pharmacy, specialty pharmacy, contracting, managed care.
- Intermediate to advanced Microsoft Excel, Word, PowerPoint, and Outlook.
- Ability to perform work with a high degree of accuracy, including data entry, proofreading, preparing and processing reports and contracts.
- Strong organizational skills.
- Ability to prioritize work.
- Effective verbal and written communication skills.
- Take initiative with job tasks and be open to constructive feedback.
- Ability to work with limited supervision and as part of a team.
- Sound decision-making abilities.
- Ability to share ideas in a constructive and positive manner.
- Ability to keep commitments.
- Ability to keep others informed of work progress, timetables and issues.
Vision, hearing, speech, movements requiring the use of wrists, hands and/or fingers. Must have the ability to view a computer screen for long periods and the ability to sit for extended periods. Must have the ability to work the hours and days required to complete the essential functions of the position, as scheduled. Must have the ability to lift and maneuver items of at least 20 pounds. Working condition include normal office setting.
Learning, thinking, concentration and the ability to work under pressure, particularly during busy times. Must be able to pay close attention to detail and be able to work as a member of a team to ensure excellent customer service. Must have the ability to interact effectively with co-workers and customers, and exercise self-control and diplomacy in customer and employee relations’ situations. Must have the ability to exercise discretion as well as appropriate judgments when necessary. Must be proactive in finding solutions.
If you are applying for a job and would like to make a request for a reasonable accommodation during any part of the employment process, submit an email to Human Resources at firstname.lastname@example.org or call (951) 296-2500 extension 1391. Please include your contact information along with the specifics of your request for a reasonable accommodation. Only inquiries regarding a reasonable accommodation request will receive a response via email or phone in a timely manner.
Nufactor is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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