Senior Contracts Specialist - Rockville Regional Offices
To 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 as outlined for Contract Specialist. Providing guidance and training (as needed) to Contracts Specialist Participating in meetings as a decision maker (as delegated by Director of Contract Administration) when needed.
Supports the day to day work of Contract Specialists to ensure all deliverables (to both internal and external customers) are completed on time, are accurate and compliant with regulatory requirements. Escalates team performance or deliverable concerns to the Director of Contract Administration.
Oversees, mentors and trains Contract Specialists and communicates problems or trends to the Director of Contract Administration. Ensures objection responses meet regulatory standards.
Oversees the peer review process (performed by the Contracts Specialists) and performs overall QA on contractual filings prior to regulatory submission. Responsible for department dashboards or reports.
Responsible for coordinating staff meetings for Contract Admin team. Including setting the agenda and monitoring the completion of assigned tasks. Also responsible for ensuring the tracking log is updated for all filings.
Serves as the primary delegate for the Director of Contracts Admin for conference calls and any relevant committee meetings
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.
Researches and stays abreast of regulations and statutes. Determines impacts of implementation of new regulations and statutes. Drafts compliant EOC language for filing submission.
Minimum eight (8) years of healthcare experience - (health care operations, audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan government experience) with a minimum of five (5) of those years of experience in a regulatory, legal or healthcare benefits related activity.
Bachelor's degree required, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Advanced knowledge of Federal HMO Laws & Regulations; OPM/FEHB Regulations; State laws such as Maryland & Virginia HMO Laws & Regulations; Federal TEFRA, COBRA, Medicare and Medicaid Laws & Regulations; and Maryland COBRA Laws & Regulations is required.
Excellent written and oral communications skills required.
Demonstrated ability to effectively use PC and/or mainframe computers required.
Advanced knowledge of current health care marketplace dynamics and **MEMBERS ONLY**SIGN UP NOW***.'s position in the market required.
Knowledge of non-**MEMBERS ONLY**SIGN UP NOW***. health insurance products, rating methodologies, and strategies required.
Demonstrated the ability to provide training to Contract Specialist or other team members as needed
Project Coordination experience preferred.
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.
Working knowledge of KMATE, BETS, DIAMOND, KPHC configurations preferred.
Knowledge of medical terminology, benefit coding, and clinical procedures preferred.
Knowledge of project management, spreadsheets, presentation graphics, and word processing preferred.
Health care, benefits, and/or insurance experience preferred.
Knowledge of non-**MEMBERS ONLY**SIGN UP NOW***. health insurance products, rating methodologies, and strategies preferred.
Knowledge of current health care marketplace dynamics and **MEMBERS ONLY**SIGN UP NOW***.'s position in the market preferred.
Maryland,Rockville,Rockville Regional Offices 2101 E. Jefferson St.
Scheduled Weekly Hours:
Mon, Tue, Wed, Thu, Fri,
Working Hours Start:
Working Hours End:
Employee Group/Union Affiliation:
Salaried, Non-Union, Exempt
Sales and Marketing
**MEMBERS ONLY**SIGN UP NOW***. is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.