OverviewThe Hospital Contracting Account Manager is responsible for managing strategic relationships with assigned hospital systems to drive high-quality, cost-effective healthcare outcomes. This role oversees hospital network performance, contract optimization, provider engagement, and reimbursement strategies while ensuring network adequacy and operational excellence. The Account Manager serves as the primary liaison between hospital partners and internal stakeholders, leading initiatives related to contracting, claims resolution, quality improvement, and provider performance. Working cross-functionally with teams including Enrollment, Medical Management, Utilization Management, Member Services, Claims, Configuration, Sales, Product, Compliance, and Provider Services, this position helps deliver exceptional member experiences and supports organizational goals for quality, affordability, and network effectiveness.
Responsibilities
- Lead end-to-end negotiation and execution of hospital and hospital-based provider contracts, including renewals, amendments, and new agreements. Drafts contracts, amendments, and other provider communications.
- Develops and manages strategic relationships with hospital managed care leads and key stakeholders, influencing contract outcomes while balancing provider needs with Plan financial and operational priorities.
Create and maintains positive provider/customer relations and coordinates with various departments (e.g. Clinical, Claims, Provider Services, Configuration) within the company to ensure provider issues, inquiries, and complaints are handled appropriately while balancing provider needs with Plan priorities.
Actively participate in various cross-functional workgroups to understand and communicate the impact of any initiatives involving network management and hospital providers.
- Performs financial, utilization, and market analyses to support contract negotiations, reimbursement strategy, and network planning for hospitals and hospital-based providers.
- Supports departmental initiatives including network expansion, regulatory changes, and strategic projects.
Qualifications
- Bachelor’s Degree or equivalent.
- Minimum four (4) years of hospital contracting, payer/provider negotiation, or network management experience required.
- Familiarity with Managed Care, NYSDOH State and CMS federal regulations is preferred. Demonstrated experience negotiating reimbursement methodologies (e.g., DRG, per diem, case rates, carve-outs) strongly preferred. Financial analysis and Excel modeling skills required.
- Strong analytical, written and oral communication and presentation skills, as well as public speaking skills.
- Ability to multi-task, work in a fast-paced environment and with minimal supervision.
- Ability to develop and maintain client relationships.
MinUSD $100,000.00/Yr.
MaxUSD $115,000.00/Yr.
