• Senior Contract Administrator

    Job Locations US-RI-Smithfield
    Req No.
    2018-9000
    Department
    Provider Network Management
    Type
    Regular Full-Time
  • Overview

    This position 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. This position will provide support in the absence of a manager.

    Responsibilities

    • Responsible for complex, high profile negotiations including the development, proposal and implementation of contractual terms as approved
    • Lead to completion provider negotiations and contracting efforts with responsible for the accuracy of all contract proposals and rate proposals and final contracts. Confirming reimbursement is accurately defined, communicated and configured while maintaining network adequacy and member access to care standards and meeting 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.
    • Assist in the development of the vision and strategy for the department and assigned functions including the identification, recommendation and recruitment of providers
    • Ensure that providers receive appropriate and timely responses
    • Serve as the lead subject matter expert ensuring optimal efficiency in area of responsibility
    • Lead and collaborate 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
    • Understand, propose and implement various industry standard reimbursement methodologies as approved
    • Provide assistance and mentorship to the Contract Administrator
    • Represent the organization in appropriate internal and external committees and meetings and facilitate internal and external meetings, as required
    • Provide reporting to internal and external parties
    • Cultivate strong business relationships internally and externally
    • Work collaboratively with provider relations to understand operational issues, providing assistance in the satisfactory resolution of as needed
    • Responsible for knowledge of CMS, Federal and State laws and requirements and other applicable industry standards and benchmarks.
    • Identify and implement medical expense savings opportunities
    • Prioritize and organize own work to meet deadlines.
    • Maintain professional growth and development.
    • Special projects and other duties as assigned
    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s 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

    Required:     

    • Bachelor’s 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)
    • Understanding of the health care delivery system and managed care principals
    • 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 lead negotiations and execute contractual relationships to align with specific corporate and department initiatives, strategic goals and objectives
    • Demonstrated understanding of contractual language, health insurance; insurance laws and regulations, including Medicare and Medicaid policies; claims processing; medical and insurance terminology and procedure and diagnostic codes
    • Advanced skills in Microsoft Office (Word, Excel, PowerPoint, Outlook)
    • Strong business communication skills (written and verbal) public relations, presentation and facilitation skills
    • Ability to manage multiple projects simultaneously
    • Ability to manage data and processes in multiple platforms
    • Ability to work cross-organizationally to achieve the goals of the company and department
    • Ability to oversee vendor relationships to ensure service levels and performance is met as contracted
    • Demonstrated experience speaking with the provider community, listening to grievances and communicating solutions with good follow-through skills
    • Demonstrated ability to successfully meet deliverables
    • Ability to travel including reliable transportation, a valid driver’s license and proof of insurance


    Preferred:

    • Three (3) or more years’ experience with commercial, Medicaid or Medicare contracting and reimbursement
    • Experience in Cognos
    • Experience in MedInsight
    • Experience in SharePoint
    • Knowledge of Quality Improvement Processes (e.g. Lean, Six Sigma) 

     

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

     

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

     

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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