• Senior Professional Contract Administrator

    Job Locations US-RI-Smithfield
    Req No.
    2018-9501
    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, with an emphasis on professional services. 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, with an emphasis on professional services, including the development, proposal and implementation of contractual terms as approved
    • Lead 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
    • Assist in the development of the vision and strategy for the department and assigned functions including the identification, recommendation and recruitment of providers
    • Cultivate strong business relationships internally and externally
    • Ensure that providers receive appropriate and timely responses
    • Identify and implement medical expense savings opportunities
    • 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
    • Provide assistance and mentorship to the Contract Administrator and support in the absence of the Manager
    • Provide reporting to internal and external parties
    • Represent the organization in appropriate internal and external committees and meetings and facilitate internal and external meetings, as required
    • Serve as the lead subject matter expert ensuring optimal efficiency in area of responsibility
    • Special projects and other duties as assigned
    • Understand, propose and implement various industry standard reimbursement methodologies as approved
    • Work collaboratively with provider relations to understand operational issues, providing assistance in the satisfactory resolutions as needed
    • 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
    • Other duties as assigned

    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)
    • Three (3)+ years’ experience with commercial, Medicaid or Medicare contracting and reimbursement
    • Three (3)+ years’ experience with professional contracting
    • 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 prioritize and organize own work to meet deadlines
    • 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 meet deliverables
    • Demonstrated experience speaking with the provider community, listening to grievances and communicating solutions with good follow-through skills
    • 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
    • Demonstrated understanding of the health care delivery system and managed care principals
    • Excellent customer service orientation
    • Excellent written and strong business communication skills (written and verbal) public relations, presentation and facilitation skills
    • Knowledge of CMS, Federal and State laws and requirements and other applicable industry standards and benchmarks
    • Maintain professional growth and development
    • Proven organizational skills and attention to detail
    • Strong interpersonal skills; builds building high quality relationships internally and externally through actively networking
    • Working knowledge in professional reimbursement methodologies including per diem, fee-for-service, capitation, bundled payments, total cost of care models, risk adjustment and Prospective Payment System (PPS), including Federally Qualified Health Center (FQHC, Ambulatory Payment Classification (APC) and Home Health Care
    • Working knowledge in professional contracting, including primary care, ancillary, ambulatory surgery center, dialysis, hospice, home care specialty care provider
    • Experience with Federal and State regulations
    • Ability to train staff, as applicable
    • Ability to travel including reliable transportation, a valid driver’s license and proof of insurance

    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)
    • Experience with National Committee for Quality Assurance (NCQA), Council for Affordable Quality Healthcare, Inc. (CAQH)
    • Experience in delegated entity oversight
    • 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

    Organizational Competencies

    • Judgement and decision making
    • Gets results
    • Collaboration and teamwork
    • Business-awareness
    • Customer focus

    Job Specific Competencies

    • Problem Solving/Analysis
    • Planning & Organizing
    • Open Communication
    • Relationship Building & Networking
    • Flexibility & Achieving Change

    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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