PRIMARY FUNCTION: Oversees, manages, and evaluates contracting opportunities, development of rate proposals, and strategic national negotiations to include Risk and Value Based Contracting.
Researches, analyzes, and reports on market trends in support of company strategic objectives.
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
* Manages and develops national contracting team. Provides ongoing training, performance feedback, and avenues for professional development
* Performs national contract negotiations including Risk, Value Based, Fee for Service, and provider specific contracts
* Performs contract language review and assists in negotiating language changes/terms/provisions with payors to maximize reimbursement, reduce exposure, and streamline administration
* Manages contract renewal process and ensures timely contract renegotiations.
* Manages, evaluates, and creates department tools, policies, and procedures to ensure workflow efficiencies and timely renewals, updates, and dissemination of payor information.
* Evaluates payor incentive programs and provides recommendations to maximize incentives
* Identifies contracting opportunities with new and existing payors.
* Oversees the management of the fee schedule evaluation process and determines potential opportunities.
* Oversees and provides direction to ensure resolution of contract financial performance issues involving Capitation, Risk, Gainshare, Pay for Performance, and Bonus arrangements.
* Develops and maintains strong payor relationships and facilitates payor meetings.
* Perform any other duties as assigned.
Will hire, train, direct, discipline, review, and supervise work of direct reports.
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.
TYPICAL WORKING CONDITIONS:
Reach above Shoulder
Handling/Fingering- (refers to the ability to manipulate items with the hands and/or fingers)
Sense of Sound
Sense of Touch
Ability to wear Personal Protective Equipment (PPE)
EDUCATION: Bachelor’s degree required
*Upon hire, and for the duration of the employment period driver’s license must be active and valid.*
EXPERIENCE: Minimum of 5 years’ experience required. Minimum of 2 years management experience required. Healthcare experience required.
KNOWLEDGE, SKILLS & ABILITIES:
1. Skilled negotiator with effective strategic planning and organizational skills
2. Risk and Value Based Contracting
3. Knowledge of Statewide Medicaid Managed Care programs
4. Proficient in research, analysis, and interpretation of financial data and trends
5. Knowledge of reimbursement methodologies and CPT, ICD10, RBRVS, and capitation.
6. Knowledge of claims, credentialing, and loading processes
7. Advanced Microsoft Office skills
8. Effective oral and written communication skills
9. Ability to manage multiple priorities and projects
10. Strong interpersonal skills
11. Ability to influence others
12. In-depth understanding of contract parameters and performance.