Director of Provider Contracting

Position Overview

Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

Responsibilities

• Oversee process of contracting physicians, medical groups, and ancillary providers.
• Evaluate and negotiate contracts in compliance with company templates, reimbursement struct standard and other key process controls.
• Manage unit cost budgets, target setting, performance reporting and associated financials models.
• Forecast and plan on-going contract renewal strategy.
• Assist with managing the Medical and Behavioral Health Provider network; ensure adequacy; ensure payment is completive and meets regulatory guidance.
• Draft and coordinate contract amendment mailings as needed, within regulatory and mandated timeframes.
• Manage, evaluate, recruit, and onboard members of the Contracting team.
• In collaboration with the Senior Director, manage provider contracting and fee schedule negotiations.
• Collaborate with the Credentialing, Provider Maintenance, and Core Configuration units to ensure contracts are implemented efficiently, accurately, and timely.
• Ensure agreements are following regulatory requirements.
• Develop and maintain contracting policies and procedures.
• Manage key contracting efforts and contracting processes.
• Negotiate agreement language and rates while securing internal approval as needed.
• Ensure agreement implementation process is followed.
• Participate and/or oversee specific projects and annual business plan.
• Upon agreement execution, ensure notification is made to internal and external parties.
• Prepare progress reports and analyses as required for discussion with senior administration.
• Implement the plans network development strategy.
• Identify solutions to non-standard requests and problems.
• Assess customer needs and requirements.
• Resolve contract related issues with participating providers and communicate with providers as needed.

Required Education, Training & Professional Experience

• Bachelor’s degree in Business Administration, healthcare, legal studies or related field required.
• Minimum of 10 years or more of experience in a Health Plan environment with knowledge/experience in contracting, reimbursement, network, or provider services, and/or vendor management healthcare environment.
• Minimum of 7 years’ payer experience including developing, implanting, and executing contract strategies across multiple products.
• 7 years of demonstrated expertise in operational and contractual quality improvement strategies.
• Deep understanding of regional health care environment and the payer/reimbursement space: ability to identify trends in healthcare that impact business and operations.
• Experience of leading and implementing strategy and business plans.
• Experience with Profit & Loss accountability.
• Demonstrated management and leadership experience with successful experience building and maintaining effective business relationships.
• Knowledge of managed care administration and standards, regulations, and laws applicable to contracting, knowledge of business and human resources administration principles, management techniques and the ability to direct and supervise personnel.

Professional Competencies

• Ability to travel within NYC on a regular basis.
• Strong time management and organizational skills; an obsessive attention to detail and follow-through.
• Proven analytical and problem-solving skills.
• Integrity and Trust.
• Customer Focus.
• Functional/Technical skills including Strong proficiency with Microsoft office suite and web applications.
• Strong leadership skills.
• Excellent written and verbal communication skills.
• Ability to thrive in a fast-paced environment, flexible to ongoing change.
• Confident, autonomous, solution driven, motivating, high standards of excellence, diplomatic, resourceful, intuitive, dedicated, resilient and proactive.
• Upbeat, positive, outgoing and a doer.
• Strong urgency toward task accomplishment.
• Ability to form effective working relationships with a wide range of individuals.