Manager-Provider Contracts

Job Summary

Identifies, evaluates and negotiates contracting opportunities to grow the existing business, develop new business, and expand provider network. In-depth understanding of health care and managed care contracting concepts, reimbursement, methodologies, and health benefit plan designs. Perceptive of general market conditions and the managed care market both provider and payor. Ensures application of appropriate business and legal protocol for contracting services to comply with organization and departmental missions.

Serves as liaison for contract communication with other organizational representatives. Manages contract department, support staff, contract document control, and renewal process for payor contracts.

• Identifies and evaluates managed care contracting opportunities to grow the existing business, develop new business with various third‑party payors, including insurance carriers, third‑party administrators, managed‑care networks, self‑funded payors, business alliances, and provider organizations, and to expand the provider network. Analyzes contract opportunities using contract guidelines to improve organization's market share.
• Negotiates contracts with various providers and third‑party payors, manages the interface to bring these negotiated contracts to closure, and informs senior management of contract activity.
• Maintains proficient knowledge of managed care contracting concepts (reimbursement methodologies, e.g., capitation, per diems, DRGs, case rates, discounted fee‑for‑service) and health benefit plan designs (PPO, POS, EPO, HMO). Extrapolates information from payors' health benefit plans and reimbursement arrangements to complete contract summaries, contract information load sheets, and other reports as required.
• Maintains current knowledge of the managed care market and trends, both provider and payor.
• Ensures that appropriate business and legal protocol is applied for contracting services to ensure compliance with organization and departmental missions; consults with legal on contracting issues.
• Serves as liaison for contract communication with other organizational representatives; manages document control of contract files.
• Manages renewal process for payor contracts, including renegotiation, and analyzes utilization data submitted for renewal to monitor contract performance.
• Performs other duties as assigned.

Minimum

Required:

3 years experience with health care contracting with health care reimbursement and health benefit plan experience.

Preferred/Desired: (none specified)

Minimum

Required:

Bachelors degree in health care administration or business administration.

Preferred/Desired:
Masters degree in health care administration or related field.

Effective in making presentations to various provider and payor groups; strong analytical, negotiation, leadership, marketing, and verbal/written communication skills.

Mid‑Senior level

Other

Management and Manufacturing

Hospitals and Health Care