Contract Manager, Managed Care Contracting

Major Responsibilities

• Responds to all inquiries relating to managed care contracts from medical center personnel, physicians and/or physicians office staff.
• Interprets contract language and ensures that the terms of contracts are communicated and implemented accurately within the system.
• Solves issues relating to health plan credentialing, claims payment, referral management, and various administrative issues.
• Collaborates with Managed Care Provider Relations staff to communicate contractual requirements, updates on policy and operational changes, and other contract-related information to various departments within the organization.
• Coordinates site visits required for credentialing for new and existing programs.
• Liaises with managed care plans to address operational issues arising under the managed care contracts.
• Meets regularly with representatives from the managed care plans to ensure contractual obligations are met and to resolve issues raised by UMass Memorial Medical Center and Umass Memorial Medical Group personnel.
• Manages contracts to ensure compliance and, with input from the Director, Legal, Finance, and other departments as appropriate, is responsible for renewing and renegotiating contract terms.
• Assists with financial analysis and negotiation of risk contracts.
• Assists in contracting for ancillary services, including home health & hospice and MRI services, and affiliate hospital risk contracts.
• Helps resolve technical and operational problems.
• Evaluates the impact of solutions to ensure goals are achieved.

Position Qualifications

• BS degree or equivalent in Business, Health Care Administration, or Managed Care Administration.
• Five years’ experience in hospital, physician office, clinical or managed care setting; thorough understanding of clinical operations, health care terminology, and current market conditions.
• Three years direct managed care-contracting experience, with emphasis on analyzing and negotiating risk contracts and thorough understanding of managed care financial arrangements and boilerplate negotiations.
• Experience with risk contracting preferred.
• Good knowledge of commercial Medicare Advantage and Managed Medicaid markets preferred.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office applications.