Senior Contracting Manager

Managed Care Contracting Position

Remote Position

Pay Range : $57,699.20 - $107,140.80

Position Summary

Under the oversight of the Director of Contracting & Credentialing, responsible for a wide variety of duties related to the development, implementation, and ongoing management of the company's managed care contracting function. Primary responsibilities include contract administration, review and analysis of contract proposals, development of managed care strategies, and a liaison role to both external and internal customers and other special projects.

Key Performance Areas

KPA 1 Contract Negotiation & Renegotiation

Job duties included but not limited to :

• Assist in the strategic development and implementation of Managed Care and Payer Contracts on a national, regional, and local level
• Negotiate and renegotiate managed care and payer contracts consistent with contracting goals
• Development of business decision support materials and proposals
• Review and analysis of contract language and reimbursement terms in existing and potential managed care agreements
• Cultivate relationships and maintain communications with health plans and payors
• Assist with the investigation and evaluation of payer markets in different states (payer mix, reimbursement issues, and state regulatory statutes)
• Oversee transitions-prepare payer target list, manage weekly oversight, prepare payer status updates for all internal departments
• Work with complex payer affiliations such as PHO's, CIN's and IPA's

KPA 2 Contract Maintenance

Job duties included but not limited to :

KPA 3 Contract Implementation

Job duties included but not limited to :

KPA 4 Payer Issues

Job duties included but not limited to :

Position Qualifications / Requirements

1. Education : Bachelor's degree from four-year college or university; or equivalent related experience preferred.

2. Previous Experience : 5 years cumulative experience in healthcare managed care contracting working on either the provider or payer sides of health care preferred. In-depth knowledge of the healthcare industry including billing and claims, medical coding, payer / provider relations, contracting processes, fee schedules and reimbursement methodologies required.

3. Core Capabilities : Work requires a professional level of knowledge in health insurance or health care administration. Work requires essential knowledge of managed care concepts, an understanding of the breadth of clinical services provided and the ability to effectively communicate (oral and written) at a highly professional level. Work requires strong analytical ability to solve complex problems. Must possess advanced interpersonal skills to effectively interface with all levels of management and staff as well as external business-related associates. Work requires teamwork and the ability to work well with all levels of the business. Must demonstrate the ability to provide leadership and effectively communicate (both oral and written) to all levels of management and staff. Must be proficient in creating and utilizing MS Excel spreadsheets and all other MS Office programs.

4. Certifications / Licenses : Valid driver's license in the state of residence is required.

5. Travel : Required for meetings and as needed to meet with payers.

6. Standard Work Days / Hours : M-F; Day