Manager, Physician Network Contracting

1 month ago

New York, United States 1199SEIU Funds Full time

Responsibilities

  • Manage the activities of physician contracting which include preparing and maintaining contracts and complex contracting and negotiations for fee for service, and value-based reimbursements with providers (e.g., large physician groups)
  • Draft single case Letter of Agreements and Long-term Letter of Agreements with providers and physician groups
  • Develop reimbursement models and negotiate renewal agreements with large physician groups and independent provider associations (IPAs)
  • Ensure timely response to provider inquiries related to contract terms and payment methodologies via email, telephone, written correspondence, and on-site/virtual meetings
  • Reinforce contract terms with Physicians, internal Fund departments, escalate time sensitive issues and ensure timely communication on network updates and changes
  • Facilitate review of escalated claims and evaluates contract terms and work with internal departments to obtain issue resolution within the prescribed timeframe
  • Act as liaison between internal departments and ensure all contract language issues, problematic administrative terms and recommendations are tracked and issued annually prior to the contract re-negotiation period
  • Manage projects including but not limited to Request for Information/Proposal, benefit changes, and other programs and initiatives as required
  • Perform additional duties and projects as assigned by management
Qualifications
  • Bachelor's degree in Business or Health Care Administration required; Master's degree preferred
  • Minimum five (5) years of experience working in a healthcare management setting required; to include two (2) years supervisory experience required
  • Proficient in Microsoft Word and Excel
  • Excellent verbal, interpersonal and written skills
  • Strong negotiation and influential skills and solid problem-solving skills
  • Ability to travel throughout the New York metropolitan area
  • Knowledge of provider contracting methodology including understanding of Accountable Care Organization (ACO) Model, Quality-Based Shared Savings Program (QSSP) and payor roles, responsibilities, and challenges
  • Knowledge and thorough understanding of government regulations and requirements as they relate to physician contracting
  • Ability to work in a fast-paced environment and foster positive working relationships, multi-task and meet deadlines

The first six months of this position will be 100% in the office for newly hired employees.

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