Payor Contract Manager

Description

The Contract Manager is responsible for the development, implementation and ongoing management of commercial fee for service and value-based payer contracts across Maine Health, and the Maine Health Accountable Care Organization (MHACO). This role is critical in supporting optimal reimbursement, maintaining the System's competitive position, and fostering strong relationships with payer organizations. The Contract Manager will work collaboratively with internal stakeholders and external partners to support the financial and operational objectives of the System and its affiliates as it relates to Payer Relations activities.

• Negotiate contractual and reimbursement tasks with market payers for all services rendered by Maine Health entities.
• Negotiate value-based agreements with payers on behalf of MHACO.
• Amend existing agreements to include services not currently under contract and/or new services, facilities, etc.
• Participate in system strategic initiatives impacting select payers, as needed.
• Create and maintain a checklist of required elements for contract language in collaboration with MH Legal.
• Inform and assist in pricing strategies to maintain MH's competitiveness in the regional marketplace in order to generate appropriate margins.

• Provide support and guidance to RCM leadership to monitor and report financial performance of assigned payer contracts versus expectations to assure achievement of negotiated rates. Recommend necessary actions to management based on contract performance.
• Identify and develop strategies to mitigate risks and sources of exposure in payer contracts.
• Work closely with RCM on operational issues that become contract issues, including attendance at payer Joint Operating Committee (JOC) meetings.
• Assure routine audits of payer data are performed to ensure compliance with contracted payment terms.
• Proactively work with Decision Support to report and refine the reporting of contract performance, analysis, and modeling tools.
• Prepare reports for committees and the boards as required.

• Establish and maintain relationships with payers and serve as a point of contact for all aspects of the relationship.
• Establish, promote, and maintain relationships throughout the Maine Health System in support of payer relations objectives.
• Field questions and provide answers or ensure appropriate staff follow up effectively.
• Provide education on new agreements as they affect stakeholders via written communications or presentations as needed. Anticipate and address hospital CFO needs for information resulting from new or modified agreements.
• Contribute to communications and education to the System utilizing the electronic newsletter, website, and educational sessions as needed.
• Attend conferences, participate in professional organizations, and/or read publications to update knowledge of trends and product development in the field.
• Develop and maintain ongoing interactions with appropriate staff and management at member organizations regarding payer contracting in conjunction with the Director of Contracting and Network Development.
• Interact with providers to identify payer trends requiring action or escalation.
• Work with other internal partners on supporting/leading select system strategies where Contracting can drive specific change or help develop new processes.

• Facilitate the approval and signature process for contracts, single case agreements and settlements.
• Create and implement, based on Management feedback and information supplied by other System entities, payer contracting processes and procedures to maximize System performance in payer relationships.
• Leverage transparency data to assure negotiated rates and rate requests are competitive.
• Stay informed of product developments and market pricing at competitor medical centers in an effort to support successful negotiations.

• Respond creatively and effectively to special projects assigned by the CFO, Vice President, and Director.
• Assist in the development of departmental goals,…