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.