Senior Contracting Negotiator Managed Care

Job Description

Effectively makes strategic recommendations to AdventHealth provider business units and senior leadership to advance AdventHealth initiatives by evaluating new managed care opportunities related to identified health plan strategies (e.g. strategic business decisions, publications, behavioral trends, new product lines, benefit design, etc.) to appropriately respond to perceived healthcare market changes.

Manages tasks to completion by developing timetables, milestones, and deadlines with the help of senior leadership to ensure the timely adherence to AdventHealth strategic goals.

Effectively communicates with coworkers, leadership, AdventHealth as well as outside business unit leaders, and health plans through verbal and written messages establishing a clear, professional, and courteous position on behalf of AdventHealth.

Refines ongoing managed care processes by developing information and documents such as contract language and negotiation strategies for the purpose of enhancing performance standards in the Managed Care department.

Represents AdventHealth as lead negotiator for assigned top-tier and mid-level tier managed care health plans in facilitating contract negotiations with AdventHealth business divisions to further AdventHealth strategic, tactical, and operational goals.

Affords the role of a subject matter expert during contract negotiations by displaying proficiency and distinction related to managed care and contract negotiation topics with the intention of maintaining strategic alignment with contracted health plans.

Sets resolution to managed care issues by collecting and interpreting contract performance information (e.g. claims volumes, quality and efficiency reports, participation gap analysis, accounts receivable data, etc.) to preserve the integrity of those contracts.

Acts as a primary liaison for the AdventHealth Managed Care department by leading or contributing to meetings and projects in service of AdventHealth strategic initiatives.

Ensures the timely start of contract negotiation activities by ensuring that all necessary information relative to achieving successful negotiation is prepared and ready by performing research and coordinating with other Managed Care or AdventHealth departmental leaders and making recommendations as needed.

Captures responsibility for the overall contracting process by coordinating with other Managed Care teams and outside business units as applicable to identify contract implementation elements and opportunities.

Exhibits research proficiency using applicable reports (e.g. financial statements, impact analyses, database systems, etc.) to effectively lead in contract negotiation and issue resolution.

Assumes responsibility as a managed care liaison to assigned AdventHealth providers by leading or contributing as needed to contracting strategy development and implementation for the purposes of advancing the initiatives of those providers within the overall scope of AdventHealth managed care strategy.

Knowledge, Skills, And Abilities

Understands the basic functions of a large integrated healthcare system.

Understands key elements of a contract as well as negotiation practices and processes.

Develops, implements, and executes research plans.

Strong organizational skills.

Self-motivated with the flexibility to multitask and restructure priorities in a fast-paced environment.

Professional attitude and conduct.

Typing: 35 wpm.

Word processing, spreadsheet, and database proficiency.

Proficiency with email, computer calendar, and web-based meetings and resources.

Excellent communication skills, both verbal and written.

Education

Bachelor's [Required]

Master's [Preferred]

Field Of Study Bachelor's in healthcare or related field Required

Master's in healthcare or related field Preferred

Work Experience

5+ training or experience in contract negotiations and/or contract administration and implementation [Required]

7+ experience in healthcare or insurance [Required]

Direct experience with managed care contract negotiation, administration, or implementation. [Required]

Experience working with multi-hospital integrated delivery healthcare system. [Preferred]

Physical Requirements

(Please click the link below to view work requirements)

Physical Requirements - https://tinyurl.com/23km2677

Pay Range

$66,170.74 - $123,073.07

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.