SUMMARY:
The Contract Administrator reports to the Manager Payer Relations and Contracting. Under the general direction and within Brown University Health policies and procedures, oversees the negotiation and completion of specific hospital and/or physician healthcare contracts. Provides essential managed care expertise to Brown University Health affiliated physicians, Brown University Health affiliates, and the payer/HMO. Evaluates and negotiates new and existing managed care contracts, and new Alternative Payment Model Contracts (ex. Bundled payments, shared savings). Coordinates contracting efforts with key departments to support new business opportunities, and maximize system performance under contract terms.
RESPONSIBILITIES:
Assists Manager and the Directors of Payer Relations and Contracting with contract negotiations; leads negotiations as assigned. Acts as liaison to the Health Plans and Brown University Health affiliates for contract related issues. Prepares and distributes contract Variance from Standard matrix.
Ensures contracts are executed, rate matrices, executive summaries and contract abstracts are prepared and distributed appropriately and timely.
Negotiates within defined parameters for specified new and existing managed care contracts. Ensures that contracts are reviewed for renewal in a timely manner, rates are renegotiated and amendments are completed, executed and distributed expeditiously.
Works closely with the Manager of Contract Modeling and Analytics and the Manager Healthcare Data and Risk Analytics to evaluate and monitor profitability of new and existing contracts. Periodically evaluates and reports on contract performance; makes recommendations for improvements. Ensures rate matrices are prepared, kept current and distributed appropriately and timely.
Identifies and supports new business opportunities with payers, physicians, affiliate departments across the system. Identifies and addresses operational issues through working with groups to support the contract and maximize compliance. Acts as the consultant on contract related issues to Brown University Health affiliates. Assists/facilitates preparation of RFP 's from contracting perspective; presents new programs and services to health plans.
Assists and participates in the development and implementation of innovative provider strategies in a quickly evolving environment. Assists in the development of package pricing for specialty services.
Functions as liaison with representatives of third-party payers on all contracting aspects, i.e. financial terms, contract language and contract implementation for select contracts.
Educates physicians and affiliate staff on managed care principles, and relevant contract terms and conditions.
Participates in councils, quality improvement teams and other such committees as required. Facilitates and leads teams related to specific contract issues. Participates in professional association activities.
Maintains quality assurance, safety, environmental and infection control in accordance with established system policies, procedures and objectives.
Reviews proposals for managed care contracts. Works closely with the Manager of Contract Modeling and Analytics and the Manager Healthcare Data and Risk Analytics to asses and analyze against system guidelines for financial impact. Recommends contract approaches (i.e., capitation, per diem, percent of charges, etc.)
Works with senior management to prepare for negotiations: develops pricing strategies, evaluates contract provisions, assesses value of contract, negotiates and communicates content and position to third party payers.
Conducts periodic audits to ensure payments are in compliance with contracts (facility, physician and report findings).
Coordinates and communicates implementation needs of new contracts to contract managers. Ensures that appropriate departments have information needed to comply with contract requirements. Provides ongoing support to maximize system performance under contract terms.
Participates in system integration activities that yield greater management efficiency and leverage potential.
Performs other duties as assigned.
MINIMUM QUALIFICATIONS:
BASIC KNOWLEDGE:
Equivalent to BS/BA in business, finance, or a health care related management field.
Knowledge of all aspects of the medical delivery system.
Strong knowledge of managed care, capitation and risk contracts.
Strong negotiating skills.
Understanding of finance, cost accounting, reimbursement and contract administration in a healthcare environment preferred.
EXPERIENCE:
Minimum of three years experience in business, finance or related administrative experience in a complex healthcare environment, preferably in managed care or reimbursement.
Minimum two years contract analysis and negotiation experience, or related reimbursement experience required.
Pay Range:
$74,672.00-$123,198.40
Location:
Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903
Work Type:
M-F 8:00am-5:00pm
Work Shift:
Day
Daily Hours:
8 hours
Driving Required:
No
