Contract Manager

Responsibilities

• Negotiates, develops and designs contractual provider (Hospital and physician) arrangements including language and pricing methodologies.
• Evaluates contractual payment methodologies in order to determine financial risk to insurer and provider (per diem, capitation, discount from charge, DRG, case rate, bundled payments, pay for performance programs, etc.).
• Ensures the design, production, and distribution of site financial, utilization and member information; ensures the production and completeness of annual site settlement reports.
• Interfaces between the Plan’s Finance department and individual sites for budget, financial reporting and settlement arrangements for all relevant products.
• Performs quantitative analyses of various financial and clinical data in order to evaluate multiple contracting options.
• Reports on performance of ongoing contractual arrangements to appropriate parties.
• Manages, coordinates and resolves operational issues related to specific areas of responsibility.
• Serves as contact person for internal departments (i.e. Claims, Finance, Care Management Services, Patient Relations, Marketing, Credentialing, Provider Relations, etc.).
• Researches, analyzes and presents recommendations to Manager regarding contractual and financial decisions.
• Maintains computerized tracking system for new and revised agreements.
• Coordinates and communicates contractual information to appropriate departments within FCHP.
• Maintains assigned provider network; physician, hospital, ancillary, and/or carve out vendor as assigned by Director or Manager.
• Prepares, updates and maintains files and database for all assigned provider contracts.
• Serves as committee member in cross-functional teams as assigned by Director or Manager.
• Services, educates and distributes information to contracted providers.
• Analyzes and presents financial reports to providers.
• Makes recommendations to providers regarding quality and cost improvements.

Qualifications

• Bachelor’s Degree Or Equivalent Experience Required.
• Master’s degree in Business Administration, Healthcare Administration, or Public Health preferred.
• Previous background in nursing or any allied health field is often valuable but not required.
• Licenses/Certifications: Valid Driver’s License and Clean Driving Record Required.
• Minimum of three years experience in managed healthcare environment(s) with related work in provider contracting, healthcare finance, provider reporting/profiling, and/or provider relations.
• Experience in provider contract negotiations, including FFS, capitation models, Hospital contracts and pay for performance models is preferred.
• Excellent analytical, strategic thinking, and creative thinking skills are required.
• Superior verbal and written skills, excellent computer skills (Word, Excel, Access) are essential to this position.