Senior Contract Negotiator, Managed Care

PRIMARY FUNCTION

Responsible for contract management, assist with review of contract language between provider and payor, assist with the development and recruitment of provider(s) for narrow networks, ensure contracts comply according to Federal and State regulations. Supports the Director of Managed Care and Contracting Manager in strategic local market/national negotiations to include Risk and Value Based Contracting. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

1. Lead contract negotiations including Risk, Value Based, Fee for Service, and provider specific contracts with the support of the Contracting Manager
2. Perform contract language review and lead discussions with payors regarding language changes/terms/provisions to maximize reimbursement, reduce exposure, and streamline administration
3. Obtain and analyze data to collaborate with Finance Planning and Analysis team on model development; utilize models to develop contract proposals
4. Generate and maintain Contract Overviews and ensure communication of accurate contract terms
5. Review and maintain contract renewal schedule to ensure contracts are negotiated timely
6. Ensure provider compliance with contractual terms and legal regulations
7. Research all state and federal regulations that may impact the performance of the contract
8. Identify contracting opportunities with existing payor Agreements
9. Monitor contract financial performance including Capitation, Risk, Gainshare, Pay for Performance, and Bonus arrangements.
10. Perform any other duties as assigned.

QUALIFICATIONS

EDUCATION: Bachelor’s degree preferred. AA plus a minimum of 5-7 years of related experience is commensurate to the education preferred.

EXPERIENCE: Minimum of 5 years’ experience required. Previous healthcare experience required.

KNOWLEDGE, SKILLS AND ABILITIES

1. In-depth understanding of contract parameters, reimbursement methodologies, contract language and performance. 
2. Knowledge in Risk and Value Based Contracting
3. Effective strategic planning and organizational skills
4. Knowledge of Statewide Medicaid Managed Care programs and Commercial payors
5. Proficient in research, analysis, and interpretation of financial data and trends
6. Knowledge of reimbursement methodologies and CPT, ICD10, RBRVS, and capitation.
7. Knowledge of claims, credentialing, and loading processes
8. Advanced Microsoft Office skills
9. Effective oral and written communication and negotiating skills
10. Ability to manage multiple priorities and projects
11. Strong interpersonal skills
12. Ability to influence others

TYPICAL WORKING CONDITIONS

• Non-patient facing
• Indoor Work
• Operating Computer
• Reach Outward
• Reach above Shoulder
• Lift/Carry 11-20lbs
• Standing
• Sitting
• Traveling
• Walking
• Bending
• Manual Dexterity

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of Sound
• Sense of Touch

PERFORMANCE REQUIREMENTS

• Develop and maintain strong payor relationships
• Perform special projects as requested / all other duties as assigned
• Negotiate Rates and Terms.
• Performs rate evaluation based on modeling and analysis and evaluate/monitor contract performance and contract compliance.
• Attend required meetings.
• 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.