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Provider Contract Management Specialist
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- The PCMS performs research to resolve issues for the Provider Contract Executives, Provider Business Operations, and Provider Enrollment.
- PCMSS role collaborates and consults with Provider Operations and other stakeholders to define business requirements, rules and standards to be used for data governance and process improvement.
- Contracts are built with "technical coding" to drive ability for alternate choices for contract language and for enhanced reporting capabilities, automation, and data governance.
- Peer review of documents, system configuration, and contract submissions to OIC is a critical function of this role to promote accuracy and reduce contract administrative and regulatory risks.
- Works with the legal department, regulatory compliance teams, and Network Management contracting staff to file documents, as applicable, with the Insurance Commissioner/Department of Insurance for each state where the Health Plan contracts with providers.
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