P.O. Box 1059
Van Alstyne, TX 75495
Phone:  903.482.1362

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Manager, Network - Provider Contracting/Network

Location: Atlanta, GA
Job Type: Direct Hire
Salary: $80,000.00 - $107,000.00
Degree: Bachelor;
Date: 7/12/2018
Job ID: 02610904
Job Description
Job description
This position reports to the Director of Provider Contracting & Network Management to support the contracting activities of the Medical Group and Health Plan.
Responsibilities include managing outside medical cost through contracting initiatives, analysis of financial reports and trends in the marketplace covering IPAs, PHOs, hospitals, and key specialty services.
Contractual arrangements will be complex and comprehensive, needing a depth of understanding of managed care; negotiation in hospital, PHO/IPA and various high volume services.

Essential Functions:
• Successfully negotiate contracts for cost reduction or contract and relationship maximization with specialty service providers. This includes facilities, individuals, networks, using a diverse range of techniques and contracting ''best practices'', to include capitation, case rates, and various fee for services arrangements.
• Management of Provider Relations Staff (5 FTEs) and mentor 2-3 Network Managers to successfully support the goals of the organization, set up goals and initiatives for provider relations staff to achieve.
• Execute and manage multiple expansion related priorities for Region.
• Develop, manage and implement Region-wide contracting strategies. This includes specialty services and the alignment of contract interests of the enterprise, Health Plan, and Network providers.
• Manage contractual relationships and ensure accurate administration of contract terms. Lead and participate in multidisciplinary teams comprised of contracted provider representatives and enterprise representatives.
• Provide ongoing intervention and assistance in the management of claims, UM and benefit issues.
• Work with QRM, Claims, the enterprise, Contracts and Benefits and other internal departments as needed to ensure the enterprise and provider understanding of and adherence to contractual obligations and intent.
• Collaborate with Performance Analysis to identify cost savings initiatives and monitor contract performance.
• Ensure contract compliance with all requirements as set forth by State and Federal agencies.
• Work closely with QRM to identify out of network providers and implement Letters of Agreement that reduce financial exposure for the enterprise.
• Supervise and execute special projects as assigned by Director.
Qualifications:
Basic Qualifications:
• BS/BA in business administration, finance or healthcare
• 7+ years of experience in healthcare administration
• Possess a successful track record of negotiating large hospital system contracts
• Ability to budget and obtain necessary medical cost targets
• Strong understanding of financial reports and the ability to manage accordingly
• Understand contract language and legal requirements for contracting
• Strong understanding of State and Federal Laws related to provider contracts
• Strong understanding of Medicare contracting and reimbursement methodology
• Broad-based knowledge of health care and the various medical delivery systems
• Understanding of various financial reimbursement methodologies used in managed care contracts; CMS DRGs, Revenue Codes, APCs, RBRVS and ASC Groupers
• Negotiation, analytical skills, and human interaction skills
• Excellent organizational and prioritization skills, the ability to work under tight deadlines, high productivity
• Strong written and excellent communication skills
• Management skills to lead a team of field representatives
• Strong presentation skills
• Ability to interact with the senior leadership team and provide recommendations on contract strategies and cost
• Expert knowledge of Excel, Access, PowerPoint and Contract Management System
• Strong Project Management skills

Preferred Qualifications:
• Masters Degree, MBA or MHA
• Managed care contracting or healthcare finance

 

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