The Senior Provider Contract Manager is responsible for developing, negotiating, managing and leading complex contractual, legal and financial arrangements with providers that ensure members have superior access to the highest quality, cost-effective providers of healthcare services.
Minimum education required
- Bachelor’s Degree , (Masters Degree preferred)
- 5 + years in managed care
Description of some duties
- 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.
- Assure contractual arrangements meet financial budgetary targets and legal and/or regulatory compliance requirements.
- 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.
- Must be well versed in market place changes and related state political environment as related to assigned services. Initiates cost savings recommendations.
- Maintains excellent written and verbal communication skills with all internal and external customers.
- Must be self-directed, exercise initiative, and seek guidance when appropriate.
- Effectively and professionally represent Company to provider community and all constituents of company
- Serve as a subject matter expert within the department and company-wide for services assigned and contracting issues in general.
- 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.
5+ years in manged health care, background in contract negotiations and management.
Experience with contracts for hospitals, PHOs, primary care or specialty physician practices.
Solid understanding of Medicare and Medicaid reimbursement methodologies with expertise in Medicare and Medicaid health care services contracting strategies.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.