Participate in the evaluation of contracting opportunities, development of rate proposals, and strategic negotiations to include Risk and Value Based Contracting. In-depth understanding of contract parameters and performance. REPORTS TO:
Reports directly to theDirector of Managed Care.SUPERVISORY RESPONSIBILITIES:
YesESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
- Preforms negotiations including Risk, Value Based, Fee for Service, and provider specific contracts.
- Perform contract language review and participate in negotiating language changes/terms/provisions with payors to maximize reimbursement, reduce exposure, and streamline administration.
- Manage contract renewal process and ensure timely contract renegotiations.
- Manage department tools and procedures to ensure renewals, updates, and payor information are communicated timely.
- Evaluate payor incentive programs.
- Identify contracting opportunities within existing payor Agreements.
- Evaluate fee schedules and determine potential opportunities.
- Monitor contract financial performance including Capitation, Risk, Gainshare, Pay for Performance, and Bonus arrangements.
- Research, analyze, and report on market trends in support of company strategic objectives.
- Develop and maintain strong payor relationships and facilitate payor meetings.
- Perform special projects as requested / all other duties as assigned.
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. Education:
Bachelor’s Degree in related field. Licensure/Certification:
*Upon hire, and for the duration of the employment period driver’s license must be active and valid.*
Experience:At least 7+ years Managed Care experience which includes working with payors and large groups. Managed Care Risk Contracting/Value Based Contracting/ Network Development/Provider Relations. Knowledge, Skills & Abilities:
- Skilled negotiator with effective strategic planning and organizational skills
- Risk and Value Based Contracting
- Knowledge of Statewide Medicaid Managed Care programs
- Proficient in research, analysis, and interpretation of financial data and trends
- Knowledge of reimbursement methodologies and CPT, ICD10, RBRVS, and capitation.
- Knowledge of claims, credentialing, and loading processes
- Advanced Microsoft Office skills
- Effective oral and written communication skills
- Ability to manage multiple priorities and projects
- Strong interpersonal skills