Payor Contract Manager

Primary Responsibilities

• Negotiate contractual and reimbursement terms with market payers for all services rendered by MaineHealth entities.
• Amend existing agreements to include services not currently under contract and/or new services, facilities, etc.
• Participate in system strategic initiatives impacting select payers, as needed
• Create and maintain a checklist of required elements for contract language in collaboration with MH Legal
• Inform and assist in pricing strategies to maintain MH’s competitiveness in the regional marketplace in order to generate appropriate margins

Performance Management & Maintenance

• Support and guide RCM leadership to monitor and report financial performance of assigned payer contracts versus expectations to assure achievement of negotiated rates
• Recommend necessary actions to management based on contract performance
• Identify and develop strategies to mitigate risks and sources of exposure in payer contracts
• Work closely with RCM on operational issues that become contract issues, including attendance at payer Joint Operating Committee (JOC) meetings
• Assure routine audits of payer data are performed to ensure compliance with contracted payment terms
• Proactively work with Decision Support to report and refine the reporting of contract performance, analysis, and modeling tools

Stakeholder Engagement

• Establish and maintain relationships with payers and serve as a point of contact for all aspects of the relationship
• Field questions and provide answers or ensure appropriate staff follow up effectively
• Provide education on new agreements as they affect stakeholders via written communications or presentations as needed
• Attend conferences, participate in professional organizations, and/or read publications to update knowledge of trends and product development in the field
• Develop and maintain ongoing interactions with appropriate staff and management at member organizations regarding payer contracting
• Interact with providers to identify payer trends requiring action or escalation
• Work with other internal partners on supporting/leading select system strategies where Contracting can drive specific change or help develop new processes

Compliance & Market Research

• Facilitate the approval and signature process for contracts, single case agreements and settlements
• Create and implement, based on Management feedback and information supplied by other System entities, payer contracting processes and procedures to maximize System performance in payer relationships
• Leverage transparency data to assure negotiated rates and rate requests are competitive
• Stay informed of product developments and market pricing at competitor medical centers in an effort to support successful negotiations

Other Responsibilities

• Respond creatively and effectively to special projects assigned by the CFO, Vice President, and Director
• Aid in the development of departmental goals, execute projects to achieve these goals, and work closely with others within the organization to continuously monitor department performance
• Act in a caring and courteous manner towards all patients, guests, visitors, students, and staff