Job Details

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:

• Bachelors degree in Health Administration, Business Administration, Public Health or a related field or an equivalent amount of education and experience
• Five (5)+ years experience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare)
• Three (3)+ years experience with commercial, Medicaid or Medicare contracting and reimbursement
• Three (3)+ years experience with facility, professional, and/or ancillary contracting
• Ability to travel including reliable transportation. If using personal vehicle, must have current, valid drivers license and proof of insurance.
• Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)
• Demonstrated understanding and experience in contract development, negotiation, financial analysis, data analysis, provider reimbursement mechanisms, contract term implementation and maintenance of contractual terms
• Ability to maintain confidentiality
• Ability to manage data and processes in multiple platforms
• Ability to manage multiple projects simultaneously
• Ability to take direction and function within a team
• Ability to work cross-organizationally to achieve the goals of the company and department
• Demonstrated ability to successfully prioritize and organize own work to meet deadlines
• Demonstrated experience speaking with the provider community, listening to grievances and communicating solutions with good follow-through skills
• Demonstrated understanding of contractual language, health care delivery system, health insurance; insurance laws and regulations, including Medicare and Medicaid policies; claims processing; managed care principals, medical and insurance terminology and procedure and diagnostic codes
• Excellent written and strong business communication and customer service skills (written and verbal) public relations, presentation and facilitation skills. Proven organizational skills and attention to detail
• Knowledge of CMS, Federal and State laws and regulations and other applicable industry standards and benchmarks
• Strong interpersonal skills; builds building high quality relationships internally and externally through actively networking
• Working knowledge of facility reimbursement methodologies including per diem, case rate, bundled payments, and Prospective Payment System (PPS), including Diagnosis-Related Groups (DRG), Ambulatory Payment Classification (APC), Ambulatory Surgery Center (ASC), Resource Utilization Group (RUGs)
• Working knowledge of facility contracting, including hospital, nursing facility, assisted living facility, adult day health care contracting

Preferred:

• Experience in an Accountable Care Organization (ACO)
• Experience in Cognos
• Experience in MedInsight
• Experience in SharePoint
• Knowledge of Quality Improvement Processes (e.g. Lean, Six Sigma)
• Ability to quickly process large amounts of information, connect and integrate data into new solutions or a better understanding of problems, and identify weakness contracts or strategies
• Has ambition that is appropriately displayed through the quality of their work. Individual is driven by a strong internal desire to have impact and influence in the organization
• Experience in delegated entity oversight

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.