Senior Contract Administrator

Job Details

Job Location

Smithfield, RI - Smithfield, RI

Position Type

Full Time

Education Level

Bachelors Degree

Travel Percentage

Occasional

Job Shift

Daytime

Job Category

Professional / Experienced

Description

The Senior Contract Administrator is responsible for the end-to-end contracting process including, contract strategy development and negotiation through to execution with an emphasis on complex, high profile negotiations. This position develops, facilitates and implements provider negotiation strategies that support strategic and corporate goals. This position is responsible for the ongoing monitoring and management of contract terms including claims system configuration, contract oversight and adherence to all managed care health plan requirements. Provides support in the absence of a manager.

Duties and Responsibilities :

Responsibilities include, but are not limited to :

• Responsible for complex, high profile negotiations, including the development, proposal and implementation of contractual terms as approved
• Leads negotiations to completion and execute contractual relationships to align with specific corporate and department initiatives, strategic goals and objectives. Responsible for the accuracy of all contract and rate proposals and final contracts. Ensuring reimbursement is accurately defined, communicated and configured while maintaining network adequacy and member access to care standards and all Plan contractual requirements
• Monitoring of contractual requirements through the ongoing management of contract terms including claims system configuration, contract oversight and adherence to all managed care health plan requirements
• Assists in the development of the vision and strategy for the department and assigned functions including the identification, recommendation and recruitment of providers
• Cultivates strong business relationships internally and externally
• Ensures that providers receive appropriate and timely responses
• Identifies and implements medical expense savings opportunities
• Leads and collaborates departmentally and cross-organizationally in the development and planning of provider contracting initiatives and efficient business processes including recommending modifications to policy and procedures, processes, workflows and communication strategies
• Provides assistance and mentorship to the Contract Administrator and support in the absence of the Manager
• Provides reporting to internal and external parties
• Represents the organization in appropriate internal and external committees and meetings and facilitate internal and external meetings, as required
• Serves as the lead subject matter expert ensuring optimal efficiency in area of responsibility
• Understands, proposes and implements various industry standard reimbursement methodologies as approved
• Works collaboratively with provider relations to understand operational issues, providing assistance in the satisfactory resolutions as needed
• Maintains professional growth and development
• Works on special projects and other duties as assigned
• Responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and / or unethical conduct by fellow co-workers, professional affiliates and / or agents

Qualifications

Qualifications

Required :

Preferred :

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.