Our client enjoy's a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package. What you will do as the Senior-Level Provider Contract Manager is develop, negotiate, manage, and lead intricate contractual, legal, and financial arrangements with providers to ensure the organization's members have great access to the highest quality, cost-effective providers and healthcare services. Must be well versed in market place changes and related state political environment as related to assigned services. Initiates cost savings recommendations.
Assure contractual arrangements meet financial budgetary targets and legal and/or regulatory compliance requirements. Must be self-directed, exercise initiative, and seek guidance when appropriate.Be the subject matter expert within the department and company-wide for services assigned and contracting issues in general.
Opportunity for a specified amount of remote work and up to 40% travel required.
- Develop, negotiate, manage and maintain provider contracts for hospitals, PHOs, primary care or specialty physician practices.
- Lead complex negotiations and/or contracting arrangements which require developing a sound business strategy for the financial and legal terms required for such contracting initiatives.
- Lead the research, development and implementation for new, creative and potentially complex reimbursement structures.
- Maintain a solid understanding of Medicare and Medicaid reimbursement methodologies for assigned services.
- Conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals and objectives.
- Develop and maintain strong provider partnerships.
- Coordinate and communicate contractual terms to other departments whose functions are necessary to the development, implementation and management of the provider arrangements.
- Lead and/or participate in cross functional meetings and projects specific to assigned provider types and serve as company-wide expert on services.
- Assure high quality data entry of contract specifications and terms into contracting data bases and completeness of all contracting processes.
- Assure network adequacy for required services meet all regulatory requirements and company growth targets.
- Assist with Provider Contract Department projects, as needed.
- Maintain high performance norms and actively participate in evaluation of own performance, establishing business goals and goals for self-development.
- Assist Senior Manager and Director of Contracting and will represent the department when Senior Manager is unavailable or tasked to other duties.
- May supervise staff and serve as a resource and mentor for other Contract Department employees.
- Perform all other duties as assigned.
Minimum Education Required
Bachelor's Degree required; Master’s Degree preferred
Minimum Experience Required
- 5+ years in managed health care
Experience working in a health care or managed care setting with a specific background in contract negotiations and management.
- Specific background in complex managed care provider contracting including Health Systems, Physician Hospital -Organizations, Facilities and/or other high level and complex contracting required.
- Comprehensive understanding of reimbursement methodologies and health care financing required.
- Solid understanding of Medicare and Medicaid reimbursement methodologies and expertise in Medicare and Medicaid health care services contracting strategies.
- Ability to identify synergy between organization and potential new and/or existing providers and effectively implement and maintain these provider partnerships for creative contracting initiatives.
- Knowledge of ICD-10 and CPT codes desired.
- Results driven, able to self-direct and work independently as well as perform in a team environment.
- Ability to multi-task, pay close attention to detail and be flexible in a fast-paced and growing organization.
- Ability to understand and set priorities, handle varying tasks simultaneously, and design work plans to track progress, resolve issues, and efficiently and effectively see tasks to completion.
- Strong organizational and analytical skills.
- Demonstrated strength in technical abilities such as excel, word, PowerPoint and other computer programs and databases.