Provider Contracting Manager

2 weeks ago

Springfield, United States Health New England Full time
Job DescriptionJob Description

SUMMARY: The Provider Contracting Manager is responsible for leading or assisting with network development activities of commercial and government programs including: preparing contract proposals in accordance with financial, operational and quality objectives, drafting and negotiating contract terms, contract implementation and maintenance. The Manager is also responsible for
designated provider types which may include hospitals, physicians, physician groups, PHO's or ancillary providers. The Manager serves as a key contact to providers and their leadership for resolution of contractual, operational and financial issues. The Manager coordinates with internal departments to facilitate ongoing service and support for contracted providers. The Manager is
also responsible for day-to-day management and development of the Provider Contracting staff including, maintaining appropriate department structure and oversight of the prospective provider process.

** This position serves as a relationship manager with the oversight of assigned vendor(s). Refer to Compliance SOP CC013 Manager, Roles & Responsibilities Check List and the Relationship
Manager Playbook for additional information.

ESSENTIAL FUNCTIONS:

Develop contract proposals and negotiate provider contracts - 25%

  • In collaboration with Director, develops strategy and selection of appropriate contract vehicle, financial models and range of terms.
  • Conducts financial modeling and analysis for provider contracts drafting and negotiation.
  • Collaborates with Director and Legal as needed for drafting non-standard contract language and terms.
  • Negotiates contract terms and reimbursement with provider or provider’s agent.
  • Collaborates with internal departments to perform financial and utilization analysis in the development and evaluation of rate proposals.
  • Collaborates with internal departments to assess provider network adequacy and identify gaps.
  • Monitors and assesses Network Expansion.
  • Collaborates with internal departments to establish and monitor quality targets.

External relations - 25%

  • Establishes and maintains positive relationships and acts as key contact for contract issues with providers and their senior leadership.
  • Takes the lead in identification and resolution of ongoing operational issues with providers, including but not limited to rate negotiation, reimbursement, billing/claims, configuration/system implementation, reporting/analytic needs, non-compliance.

Staff management and development - 20%

  • Manages, trains, coaches and develops the Provider Contracting Department staff.
  • Manages staff workflow and priorities.
  • Provides individual and feedback coaching to Provider Contracting staff on consistent basis to ensure maximum performance potential via regular one-on-one meetings.
  • Develops staff performance plans and conduct formal performance appraisals and appropriate disciplinary action in accordance with HNE Human Resource policies and procedures.
  • Maintains appropriate department structure to accommodate all provider types such as, Hospitals/PHOs, Group, Individual and Ancillary provider contracts and amendments.
  • Oversight of prospective provider process to align with network adequacy
  • Oversight of hiring new staff members
  • In collaboration with Network Operations Director, develops and manage the department annual budget

Implementation, process management and improvement -15%

  • Collaborates with internal departments and providers to implement and monitor financial and operational contract obligations
  • Establishes and enhance processes necessary for compliance with contractual obligations
  • Identifies business improvement opportunities for improving efficiencies, reducing expenses, or streamlining operations.
  • Oversight of department metrics including but not limited to, pended claims, department in-box inquires, case rates, number of prospective provider requests.
  • Collaborates with key stakeholder departments to develop and produce HNE payment policies.
  • Identifies, creates and implements policies and procedures and workflows to document key department responsibilities and tasks.
  • Assumes project leadership and participate with cross-functional teams.

Internal relations - 15%

  • Contributes to the development and achievement of organizational and departmental objectives through participation in Network Strategy meetings, PUG meetings, and other planning or performance-oriented work groups.
  • Meets on a regular basis with key stakeholder managers to discuss and review cross-departmental issues. Key stakeholder departments include, configuration, provider relations, provider credentialing, provider enrollment, claims, medical management and payment integrity.
  • Participates in Manager’s Team meetings and initiatives.
  • Educates internal management and staff on provider agreements.
  • Identifies opportunities for new or enhanced contractual relationships or collaborations with providers.

MINIMUM REQUIREMENTS:

Bachelor's degree in Business, Finance or related field, plus 5-7 years of experience in the health care industry (at least 3 years in managed care contracting), or an equivalent combination of education and experience.

  • Strong knowledge of commercial and government programs reimbursement methodologies and risk sharing models.
  • Proficient in Microsoft Word, Excel and PowerPoint.
  • Ability to use financial and utilization data to formulate rate proposals within budgeted financial targets and evaluate financial impact of changes in payment terms.
  • Initiative and ability to solve problems at the strategic and tactical level.
  • Demonstrates solid communication, interpersonal, relationship-building and negotiation skills
  • Ability to form and lead teams as necessary for development, and implementation of new or modified policies, programs or processes to support provider contracting objectives.
  • Demonstrates team leadership, facilitation and coaching skills.

WORKING CONDITIONS: Works in a standard office-based environment

Occasional travel required

SUPERVISORY RESPONSIBILITIES:

Direct Reports:

  • Sr Provider Contracting Specialist
  • Provider Contracting Specialist
  • Network Operations Coordinator

  • Provider Contracting Manager

    5 days ago

    Springfield, United States Health New England Full time

    Job DescriptionJob DescriptionSUMMARY: The Provider Contracting Manager is responsible for leading or assisting with network development activities of commercial and government programs including: preparing contract proposals in accordance with financial, operational and quality objectives, drafting and negotiating contract terms, contract implementation and...

  • Contract Specialist

    Found in: beBee jobs US - 3 weeks ago

    Springfield, Illinois, United States Department Of Homeland Security Full time

    Summary Securing Travel, Protecting People - At the Transportation Security Administration, you will serve in a high-stakes environment to safeguard the American way of life. In cities across the country, you would secure airports, seaports, railroads, highways, and/or public transit systems, thus protecting America's transportation infrastructure and...

  • Contract Specialist

    Found in: beBee jobs US - 2 weeks ago

    Springfield, Illinois, United States Department Of Homeland Security Full time

    Summary Securing Travel, Protecting People - At the Transportation Security Administration, you will serve in a high-stakes environment to safeguard the American way of life. In cities across the country, you would secure airports, seaports, railroads, highways, and/or public transit systems, thus protecting America's transportation infrastructure and...

  • Contract Specialist

    Found in: beBee S US - 7 days ago

    Springfield, United States Department Of Defense Full time

    Summary Contract Specialists plan and manage acquisitions to procure a variety of products and services for NGA. They interact with customers to develop and implement an acquisition strategy, solicit and evaluate proposals, and negotiate and award contracts. They also administer...

  • Contract Specialist

    Found in: beBee jobs US - 6 days ago

    Springfield, Illinois, United States Department Of Defense Full time

    SummaryContract Specialists plan and manage acquisitions to procure a variety of products and services for NGA. They interact with customers to develop and implement an acquisition strategy, solicit and evaluate proposals, and negotiate and award contracts. They also administer contracts, including monitoring contractor performance, preparing modifications,...

  • Contract Specialist

    Found in: beBee jobs US - 4 days ago

    Springfield, Illinois, United States Department Of Defense Full time

    SummaryContract Specialists plan and manage acquisitions to procure a variety of products and services for NGA. They interact with customers to develop and implement an acquisition strategy, solicit and evaluate proposals, and negotiate and award contracts. They also administer contracts, including monitoring contractor performance, preparing modifications,...

  • Contract Specialist

    6 days ago

    Springfield, United States National Geospatial-Intelligence Agency Full time

    Summary Contract Specialists plan and manage acquisitions to procure a variety of products and services for NGA. They interact with customers to develop and implement an acquisition strategy, solicit and evaluate proposals, and negotiate and award contracts. They also administer contracts, including monitoring contractor performance, preparing modifications,...

  • Supervisory Contract Specialist

    Found in: beBee jobs US - 3 weeks ago

    Springfield, Illinois, United States Department Of Homeland Security Full time

    Summary Securing Travel, Protecting People - At the Transportation Security Administration, you will serve in a high-stakes environment to safeguard the American way of life. In cities across the country, you would secure airports, seaports, railroads, highways, and/or public transit systems, thus protecting America's transportation infrastructure and...

  • Contract Specialist

    1 week ago

    Springfield, United States Gap International Full time

    GAP INTERNATIONAL– A unique, purpose-driven, consulting companyGlobal Management Consulting firm Gap International, based in the Philadelphia area, is looking for someone with a background in corporate contracts to join our team. This role requires the ability to draft, negotiate, and proofread consulting contracts between Gap International and our...

  • Contract Specialist

    Found in: Appcast Linkedin GBL C2 - 3 weeks ago

    Springfield, United States Gap International Full time

    GAP INTERNATIONAL– A unique, purpose-driven, consulting companyGlobal Management Consulting firm Gap International, based in the Philadelphia area, is looking for someone with a background in corporate contracts to join our team. This role requires the ability to draft, negotiate, and proofread consulting contracts between Gap International and our...

  • Contract Specialist

    2 weeks ago

    Springfield, United States Gap International Full time

    GAP INTERNATIONAL– A unique, purpose-driven, consulting companyGlobal Management Consulting firm Gap International, based in the Philadelphia area, is looking for someone with a background in corporate contracts to join our team. This role requires the ability to draft, negotiate, and proofread consulting contracts between Gap International and our...

  • Contract Specialist

    6 days ago

    Springfield, United States US National Geospatial-Intelligence Agency Full time

    **Duties**: 1. Conduct market research, and lead development and implementation of acquisition plans/strategies for complex requirements, coordinating with the program office to clarify issues; Independently prepare complex requests for proposals with mínimal supervision; Mentor and coach junior specialists on the preceding 2. Review proposals independently...

  • Contract Specialist

    Found in: beBee S US - 3 weeks ago

    Springfield, United States Department Of Homeland Security Full time

    Summary Securing Travel, Protecting People - At the Transportation Security Administration, you will serve in a high-stakes environment to safeguard the American way of life. In cities across the country, you would secure airports, seaports, railroads, highways, and/or public transit...

  • Contract Specialist with Security Clearance

    Found in: Dice One Red US C2 - 3 days ago

    Springfield, United States Department of Defense Full time

    Duties ADDITIONAL INFORMATION: The National Geospatial-Intelligence Agency (NGA) serves as the world leader in providing timely, relevant, accurate and actionable geospatial intelligence (GEOINT). NGA's civilian, military and contract personnel evaluate imagery, maps, charts, multiple layers of foundation data - such as terrain, elevation and gravity - and...

  • Contract Specialist with Security Clearance

    Found in: Dice One Red US C2 - 6 days ago

    Springfield, United States Department of Defense Full time

    Duties ADDITIONAL INFORMATION: The National Geospatial-Intelligence Agency (NGA) serves as the world leader in providing timely, relevant, accurate and actionable geospatial intelligence (GEOINT). NGA's civilian, military and contract personnel evaluate imagery, maps, charts, multiple layers of foundation data - such as terrain, elevation and gravity - and...

  • Director of Contract Compliance

    Found in: Resume Library US A2 - 2 weeks ago

    Springfield, Massachusetts, United States Viability Full time

    Job Description The Director of Contract Compliance Supports program services quality and program and agency compliance in service to our mission by managing all aspects of contract and amendment intake, contract modifications, processing, execution, tracking, communication, file maintenance and storage. Manage intake of all proposed contracts and...

  • Management Analyst

    Found in: beBee jobs US - 2 weeks ago

    Springfield, Illinois, United States Department Of The Navy Full time

    Summary You will serve as a Maritime Systems Project Manager in the Research and Development Support Activity (RDSA) Technology Directorate, organized within the Naval Intelligence Activity (NIA). DutiesYou will plan and manage elements of an applied undersea research and development program to improve existing capabilities or develop new capabilities to...

  • Ukrainian Contract Linguist

    Found in: beBee S US - 2 weeks ago

    Springfield, United States beBee S US Full time

    JOB DESCRIPTION The FBI is seeking individuals proficient in Spanish, Persian-Farsi, Pashto - Afghani, Arabic, Ukrainian, French, Haitian Creole, Somali, and Hindi who are interested in being contract linguists. Contract linguists are self-employed and provide valuable services, though they are not employees. At the FBI, contract linguists use their...

  • Management and Program Analyst

    Found in: beBee jobs US - 2 weeks ago

    Springfield, Illinois, United States Department Of Homeland Security Full time

    Summary This position is located in the Department of Homeland Security (DHS), in the Office of Biometric Identity Management (OBIM).The primary purpose of this position is to serve as a Management and Program Analyst and Contracting Officer Representative (COR) providing managers with objectively based information for making decisions on the administrative...

  • Provider Enrollment/Application Specialist

    4 days ago

    Springfield, United States Springfield Clinic Full time

    Job Description The Provider Enrollment/Application Specialist is responsible for preparing and submitting the credentialing application and supporting documentation to enroll individual physicians, locations with payers. This position will collaborate closely with Payer Relations, Patient Accounting, and Managed Care representatives. Job Relationships...