JOB OVERVIEW
This role is responsible for negotiating and executing assigned managed care payer contracts. The ideal candidate will be a proactive self-starter, able to independently organize, plan, and execute contract negotiations, and deliver results, based on department parameters. This individual will also utilize their excellent communication and negotiation skills to research and facilitate resolution of contract and payer-related operational issues, as well as manage special projects within the department.
ESSENTIAL FUNCTIONS
- Direct the development, implementation, and reimbursement contract programs with managed care plans, commercial and private payers for all states.
- Develop payer strategies, relationships, and payer contracts to drive a clear and effective negotiation strategy, reimbursement structure, contract renewal planning process, and contract implementation that aligns with organizational goals.
- Performs portfolio financial analysis on contract activity for the organization necessary to support the accuracy and profitability of managed care contracting initiatives
- Preparing and utilizing financial analyses and modeling to lead our focus to develop strategies for payer proposals
- Function as the organization’s liaison with provider payors to identify, develop, negotiate, and manage provider payer agreements.
- Provide guidance to credentialing & licensing efforts to ensure all credentialing is completed timely and accurately within established guidelines
- Manage complex contracting and negotiations for fee-for-service, value-based, pay for performance contracts and amendments.
- Lead the rate and language negotiation discussions with the payors
- Provide strategic leadership around negotiating contracts for closed networks.
- Works closely with the Company's Billing Office as needed when rates received by payors vary from the contract.
- Maintains insights and communicates marketplace changes for payors, networks, reimbursement issues and changes in legislation or in guidelines at the state and federal levels
- Ensure contract files are in order and kept up to date and archived in compliance with records management policies and procedures.
- Update internal partners on contracting efforts, needs, and processes. Provide guidance and training for executed contracts
PROFESSIONAL REQUIREMENTS
- Five plus years contracting and negotiating experience involving complex healthcare delivery systems and organizations required
- Knowledge of Laboratory negotiation and contracting (preferred)
- Operates with a sense of urgency and passion to deliver results
- Knowledge of complex reimbursement methodologies, including fee for value or incentive-based models strongly preferred
- Proven portfolio of strong client relationships where an immediate contracting impact can be realized.
- Experience with analyzing and reporting sales data to identify issues, trends, or exceptions to drive improvement of results and find solutions.
- Understanding and experience with hospital, managed care, and provider business models
- Excellent time management skills and the ability to prioritize work
- Attention to detail and problem-solving skills
EDUCATION AND EXPERIENCE REQUIREMENTS
- Bachelor's degree in a related field (required) OR
- Equivalent work experience on Payer and Provider side (required)
KNOWLEDGE, SKILLS AND ABILITIES
- Exceptional oral and written communication skills
- Knowledge and experience with Microsoft Office
- Effective time management skills
PHYSICAL AND ENVIRONMENTAL DEMANDS
- Position requires sitting, walking, reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing.
- Position requires the ability to lift up to 50 lbs.
United States
