Contract Negotiator IntermediateMaitland, FL

Contract Negotiator Intermediate

Hospitals, medical centers and facilities need more than physicians, nurses and specialists delivering care to our patients. A truly successful health care organization needs a thoughtful, dedicated, steady and experienced team working behind the scenes to make sure communities around the country receive the health care they need.

If you've also been interested in working in the health care field but aren't a health care provider, a corporate career at AdventHealth may just be the perfect fit. We're a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.

Start your journey with a health care career at AdventHealth Corporate.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

All the benefits and perks you need for you and your family:

• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support

Shift: Monday-Friday hybrid (3 days onsite) 8am-5pm

Job Location: Altamonte Springs, FL

The role you will contribute:

This position is responsible for negotiation support with top-tier payer contracts as well as direct and indirect negotiation, review, and completion of assigned mid-level and low-level tier payer contracts. Duties as assigned include assisting in strategic managed care contracting initiatives as directed by AHS leadership; managed care contract review, interpretation and analysis, negotiation, reporting, implementation for assigned low-level and mid-level tier payer contracts; and issue resolution across multiple entities including hospitals and/or physician practices in Florida as well as ancillary service providers owned, employed, or operated by AHS. This position may be called to lead strategic managed care contracting initiatives for individual provider entities. Facilitates compliance of contract terms for assigned payers by leading in strong working relationships with department staff, various hospital and provider staff, and leadership at all AHS-Florida regions, ancillaries, and external managed care payers. Actively participations in outstanding customer service and serves as a primary liaison for maintained relationships that are equally respectful of all. Diligently assists with the business relationship and advances AHS strategic and tactical objectives with each assigned payer.

The value you will bring to the team:

• Negotiation-15% Represents Adventist Health System as lead negotiator for assigned mid-level and low-level tier managed care health plans in facilitating contract negotiations with AHS business divisions to further AHS strategic, tactical, and operational goals. Contributes to contract negotiations by providing applicable subject matter expertise related to specific managed care or contract negotiation topics to contribute to strategic alignment with contracted health plans. Seeks resolution to managed care issues by collecting and interpreting contract performance information (e.g. claims volumes, quality and efficiency reports, participation gap analysis, accounts receivable data, etc.) to preserve the integrity of those contracts. Shows an understanding of managed care contract language related through interpretation of both operational provisions and payment methodology to assess opportunities for improvement in the contracting process. Applies negotiation services by contributing to meetings and projects, acting as a primary liaison as assigned in service of AHS strategic initiatives. Contributes to the timely start of contract negotiation activities by compiling information through research and coordination with other Managed Care or AHS departmental leaders and making recommendations as requested.
• Systems (5%) Accepts responsibility for the contracting process relative to assigned health plans by coordinating with other Managed Care teams and outside business units as applicable to identify contract implementation elements and opportunities. Exhibits aptitude in conducting research using applicable reports (e.g. financial statements, impact analyses, database systems, etc.) to effectively contribute to contract negotiation and issue resolution. Coordinates with multiple internal teams (e.g. Contract Management, Finance, etc.) and external teams (e.g. PFS, Pre-Access, etc.) to ensure that contracting information is correct and up to date in all applicable Managed Care documentation and resources.
• Regional Representation (15%) Assists the strategy development and implementation of assigned AHS providers by serving as a managed care liaison to help advance the initiatives of those providers within the overall scope of AHS managed care strategy. Assists in the identification and resolution of contract performance issues for assigned AHS providers by serving as a managed care liaison to help maintain effective relationships between those providers and contracted health plans. Promotes strong relationships between assigned health plans and AHS providers as well as AHS as an entity by effectively managing relationships between collaborative business units on either side to facilitate long term partnerships between AHS and contracted health plans. Assists AHS provider business unit and senior leadership in strategy development advancing AHS initiatives by evaluating new managed care opportunities related to identified health plan strategies (e.g. strategic business decisions, publications, behavioral trends, new product lines, benefit design, etc.) to appropriately respond to perceived healthcare market changes.
• Deadlines and Timeliness (15%) Completes tasks in a timely manner by adhering to timetables and expectations established by senior leadership, contributing to the effective adherence to AHS strategic goals. Achieves effective performance by displaying frequent self-directed and highly motivated levels of activity contributing to a satisfactory work pace with minimal direct supervision. Collaborates in group-oriented tasks by participating as an engaged member in committees and workgroups to comply with the directives and expectations as assigned to the group. Assists coworkers within the Managed Care department by providing support and expertise relative to assigned negotiator job duties to help the timely completion of projects assigned to others. Effectively adjusts in responding to changing priorities by effectively adapting to new expectations and situations to contribute to changes in strategic initiatives.
• Communication (10%) Effectively communicates with coworkers, leadership, AHS as well as outside business unit leaders, and health plans through verbal and written messages establishing a clear, professional, and courteous position on behalf of AHS. Contributes to meaningful discussion by leading or participating as necessary in meetings, including planning, scheduling, and coordinating such meetings with health plan representatives as well as AHS provider staff and leadership, to maintain an appropriate and effective of communication with AHS Managed Care. Provides updates related to ongoing contract negotiations by ensuring the timely communication of updates (e.g. issues, requests for information, changes to negotiation parameters, etc.) to Managed Care leadership, AHS provider staff and leadership, and health plan representatives as applicable, so that appropriate adjustments can be made to contract strategy and action. Collaborates with the Managed Care contract administration team to provide timely notification and follow-up as appropriate to AHS provider departments (e.g. Revenue Management, Medical Management, PFS, Pre-Access, etc.) and senior leadership for the purposes of advising as to parameters of contract completion, implementation, and performance. Assists in the facilitation of communication between leadership across AHS providers as applicable by sharing contracting strategy and initiatives for the purpose of streamlining operational performance throughout AHS. Exercises care and respect with regards to protected health information (PHI) as well as trade secrets and proprietary information by ensuring deliberate and secure communication as appropriate to ensure the protection and safety of sensitive information.
• Support (10%) Supports the overall mission of AHS through mindful and focused work in alignment with the role of the Managed Care department. Participates in contract negotiations and other managed care projects in all payer tiers by supporting other lead negotiators to fully execute Managed Care strategic initiatives. Adapts to changing needs by performing special projects and tasks as assigned to improve the role and function of the Managed Care department. Effectively supports managed care teams and AHS provider departments to identify, quantify, and resolve financial and operational issues related to accounts receivable, utilization management, quality assurance, billing, pre-access, care management, and other related issues through ongoing regular job duties and special projects. Contributes to the financial goals and viability of the organization and its business units by contracting appropriate rates and terms in accordance with AHS directives and market standards for the overall financial success of AHS providers.
• Performance Standards (10%) Ensures that job duties and tasks are performed appropriately by adhering to applicable internal policies set forth by AHS and its associated providers to further the strategic initiatives of the organization. Ensures that job duties and tasks are performed appropriately by abiding by all applicable rules, regulations, and laws prescribed by any authoritative governing body (e.g. State of Florida, AHCA, CMS, etc.). Supports ongoing managed care processes by assisting in the development of information and documents such as contract language and negotiation strategies for the purpose of enhancing performance standards in the Managed Care department.
• Development, Education and Training (15%) Contributes to the professional growth and development of others by or participating in managed care