About The Role
BHPS is seeking a Contract Manager responsible for the contracting and maintenance of the relationship with network health systems in their assigned territory or specialty. This also includes the recruitment, and management of the provider network inclusive of hospitals and physician groups in the New York metro market. The successful candidate will perform all of the requisite due diligence activities to identify and secure new relationships and contracts as needed with providers and re-contract with existing providers to ensure cost effective and competitive arrangements. The Contract Manager will also coordinate with other areas as appropriate to incorporate a sound strategic approach to provider network development.
The Contract Manager is a strategic and operationally oriented professional that will help build partnerships with our network, bring an analytic mindset to discussions and manage and execute projects including network development and provider outreach. Success in this position is based on strong communication skills and solid relationships with internal and external stakeholders.
*Please note, this position is a hybrid position and can be based in our Long Island office.
Primary Responsibilities
• Review, analyze, negotiate, implement, and maintain existing contracts with an understanding of professional rate schedules and contractual language.
• Identify network development opportunities through financial analysis, client requests, and product development.
• Define performance improvement opportunities.
• Implement new and evolving strategic contract initiatives including alternative payment methodologies, e.g. bundling, value-based payment, pay for performance.
• Analyze reports on cost, utilization, claim submission patterns and outcomes. Prepare presentations on subsequent findings.
• Develop, implement, and support the ongoing efforts to build new network solutions and deploy solutions as appropriate.
• Assist in resolution of provider issues, including root cause analyses, mediation between parties, and strategic relevance to the organization and its clients.
• Partner with different areas for outstanding payments, medical management, and provider policy.
• Other duties and projects as assigned and specified by supervisor in line with department and company needs.
Essential Qualifications
• Minimum 5 years in a provider or hospital administration role.
• Strong understanding of contract language.
• Strong understanding of professional provider cost structures and reimbursement methodologies.
• Sound knowledge of healthcare contracting.
• Demonstrated analytical & negotiation abilities, with excellent communication and presentation skills.
• Ability to multi-task.
• Organized and methodical.
• Customer service skills.
• Proficiency in Excel.
Preferred Qualifications
• 5 years in a provider contracting role with existing market relationships.
• Experience in financial or actuarial modeling.
• Expert proficiency in Excel.
• SQL and access experience.
• Understanding of provider experience and clinical operations.
• Revenue cycle management.
• Master's Degree.
Come be a part of the Brightest Ideas in Healthcare™.
